Experience

BILLING SOLUTIONS, LLC

• United States
• Financial Services
• 1 - 100 Employee

• Concurrent Review Specialist

  • Oct 2019 - Present

  Complete Initial, concurrent, Peer Reviews, Expedited Appeal Reviews, and retrospective reviews in a timely manner to ensure continuous coverage. Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners. Collaborate with Clinicians daily in order to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources. Provide Customer Service to accounts Prepare and submit Appeals for any LOC denials Show less



Pyramid Healthcare

• Quakertown, PA

• Utilization Review Coordinator

  • Dec 2017 - Oct 2019

  Coordinate with clinical team and insurance company care managers to ensure clients receive and maintain funding for drug and alcohol disorder rehabilitation services. Coordinate with clinical team and insurance company care managers to ensure clients receive and maintain funding for drug and alcohol disorder rehabilitation services.



Bucks Mont Eye Associates

• Sellersville, PA

• Patient Care Coordinator

  • Aug 2015 - Dec 2017

  Expedite patient services within a dynamic ophthalmology/optometry practice • Co-Manage Patient Support program to connect patients with financial assistance for costly drugs and treatments. *Manage incoming calls, triage urgent situations, and resolve issues of scheduling and billing and coordinate with providers and insurers Expedite patient services within a dynamic ophthalmology/optometry practice • Co-Manage Patient Support program to connect patients with financial assistance for costly drugs and treatments. *Manage incoming calls, triage urgent situations, and resolve issues of scheduling and billing and coordinate with providers and insurers



Salisbury Behavioral Health

• Horsham, PA

• Assistant Program Director

  • Feb 2015 - Jul 2015

  •Supervised one employee while managing a residential program for 20 individuals with chronic and persistent mental illness. •Supervised one employee while managing a residential program for 20 individuals with chronic and persistent mental illness.



Quality Progressions

• United States
• Individual and Family Services
• 1 - 100 Employee

• Supports Coordinator

  • Mar 2013 - Apr 2014

  Served as liaison between intellectually disabled individuals, their family support team, State & County Administrative Entities (AE), and provider agencies *Led annual review meetings to develop Individualized Service Plans (ISPs) *Advocated for medical & behavioral supports required by the client *Audited delivery of client services to assure compliance with agreed upon ISPs *Adhered to strict federal & state follow-up schedules and e-Record documentation to ensure clients’ quality of life & delivery of agreed upon services via provider agencies Show less



Sights for Hope

• United States
• Non-profit Organizations
• 1 - 100 Employee

• Caseworker

  • Nov 2010 - Mar 2013

  Worked with the visually impaired to develop a plan to enhance their independence. Triaged client applications for essential public services *Established relations with other local non-profit organizations to ensure continuity of care and proper delivery of services to clients *Adhered to strict follow-up schedules to ensure clients’ quality of life and the appropriate delivery of services via provider agencies *Developed relationships with animal welfare non-profits to arrange essential services for the pets of visually impaired clients Show less