Conversations from the Leather Lounge: Priscilla J. Alfaro, M.D. ’89


May 6, 2014

Hometown: Baytown, Texas

Residency: Pediatric Residency-All Children’s Hospital- St. Petersburg, FL, July 1989-June 1992.  (Intern of the Year-1990)

Current Position:  National Medical Director, RPM, WellPoint Government Business Division.  I am involved with Medicare and Medicaid reimbursement policies, coding guidelines, and healthcare fraud, waste, and abuse concerns.

What is your fondest memory of your time at UTHealth Medical School?

The life-long friends are the fondest. I feel I can call any one of them at any time and pick up where we left off. But the Freshman Retreat was a wonderful way to start medical school. Building and encouraging the social bonds in medical school is a necessary component of developing a network of support throughout our careers.

What are your hopes for today’s UTHealth Medical School students?

I hope that our medical students are not disillusioned or side-tracked by the changes that are going on in health care. As long as they stay focused on “first do no harm” and quality patient care, they can attain satisfaction in this profession. Also, a medical school degree offers them countless opportunities, in addition to the traditional pathway thru residency and private practice.

What’s a day on the job like?

I work with Reimbursement issues in a Medicaid and Medicare managed care environment and interact with medical coding, program integrity, provider education, hospital bill audits, code editing, medical policy, and disputes/appeals. I am also the clinical director for our Medicaid Special Investigative Unit (SIU). Though I no longer interact directly in patient care, I keep the patient’s needs and quality of care a priority. I interact with nurses, coders, investigators, auditors, and data analytics personnel on a daily basis. It’s a very unique and interesting environment.

What skill is most vital to your job?

Communication is the most important. Whether it is through a PowerPoint presentation, email, in person, or on the phone, if the message isn’t relayed accurately and timely, there is no forward progress. Also, if people sense you are genuinely passionate about what you are doing, they are more apt to partner.

What’s on your iPod?

Current songs like “Happy” by Pharrell, some salsa, jazz, and Hawaiian, and lots of country songs (lots). No rap.

What is the one thing you can’t live without and why?

Books. I have always enjoyed reading and find a tremendous amount of satisfaction in keeping my mind open to learning new concepts.

What fulfills you most?

Knowing I helped someone else achieve a goal. Anytime I can assist someone else to attain whatever knowledge, website, link, or connection they need, I am grateful for their success.

What has been your greatest adventure?

I completed a women’s triathlon in 2007 with a couple of friends. I’ve hiked in Molokai, scuba dived in a cave, and swam with dolphins, but completing a physical feat I never thought I could accomplish was my greatest adventure- for now.

What are your three all-time favorite books/magazines/blogs for leisure reading?

Harry Potter series (thanks to my kids), Food magazines/blogs (I’m a major foodie), and Maya Angelou.

What is your favorite word?

I love this question. It used to be “bliss”, which also reminded me of the chocolate candy! Then it was “hope”. Now, it is “shine”. I aspire to be a positive influence in people’s lives.