Experience

Greystone Health Network

• United States
• Hospitals and Health Care
• 400 - 500 Employee

• Managed Care Intake Coordinator

  • Jan 2019 - Present

  • Responds to telephone and online authorization of routine Home Health Services.• Verifies insurance coverage and benefits with Health insurance companies to gather policy benefits/limitations(e.g.,deductible amount, co-payment, effective date, pre-existing clauses, levels of care, pre-authorization requirement, visitlimitations, documentation required to process claims, etc.) to ensure the providers are appropriately paid.• Coordinate authorizations for the services associated with Home Health Care patients.• Act as liaison between the agency and insurance companies.• Know the latest Managed Care and Medicare Contract guidelines.• Ensure compliance with all regulations regarding state specific case mix. Obtain Insurance authorizations for patientsSkilled Nursing, Physical Therapy, Occupational Therapy, Hospice and SNF to include initial, rectifications and anyadditional authorizations needed to meet the patient's plan of care.• Maintain knowledge of the payer's provider contracts and authorization requirements. Communicate with representativesin a professional manner with all documentation needed to secure authorizations to meet patient goals.• Accountable for receiving, screening and processing all referral information.• Secured patient demographics, insurance coverage, physician and current health status, including clinical history andphysical information, medications, lab work, procedures performed with results and social history.• Audit intake documents for completeness.• Establish and maintain a positive working relationship with current and potential referral sources.• Input accurate authorization information in our electronic medical system daily.• Enter new patient referral into HCHB system daily.• Follow up with physicians on outstanding orders.• Upload documents to patient chartsAssist with weekend on call and scheduling as needed.



Kindred at Home

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Care Team Coordinator/Scheduler

  • Aug 2012 - Jul 2020

  Responsibilities•Receive and enter data for new and current patients and employee records.•Create, maintain and update the clinician’s schedules according to authorizations and patient needs. Maintainclinician’s availability lists.•Serve as the point of contact for all interactions with clinical team members, administrative associates, referralsources and patients.•Ensure adherence to company policies associated with record establishment, retention, maintenance andconfidentiality.•Prepare clinical records for new patients upon receipt of referral. Complete quantitative administrative reviewof clinical records at start of care and upon patient discharge.•File incoming documents daily. Maintain a control procedure for active patient files. Maintain a tracking systemto ensure clinical records are current according to company policy and regulatory requirements.•Partner with clinical resources to oversee patient intake and inquiries and assess patient needs.·Process payroll on a daily basis.



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Customer Service/Claims Representative

  • Sep 2010 - Aug 2012

  • Answered incoming high volume calls in a professional manner• Provided excellent customer service• Rerouted claims to appropriate area• Quoted member benefits to providers• Verified precertification for CPT HCPC codes• Verified referrals submitted from Primary Care Physicians• Handled claim appeals and reconsiderations• Handled and inquiried preauthorization's• Updated provider Tax Identification Number in system• Inquiried member referrals on file



JCPenney

• United States
• Retail
• 700 & Above Employee

• Sales Supervisor

  • May 1999 - Sep 2010

  • Provided excellent customer service• Supervised children's, women's apparel and men's divisions.• Ensured creation of shopping environment to encourage customers to purchase merchandise and services.• Helped set floor according to set sell planners and company's core standards.• Participated in all sales and customer service activities.• Trained and coached newly assigned and existing associates in sales skills, product knowledge, visualstandards, and merchandise maintenance to create pleasant customer experience and strengthen customerloyalty.• Answered incoming phone calls transferring customers to the correct extension in a proficient and timelymanner.• Performed annually performance appraisals.• Interviewed candidates for open positions.• Handled customers concerns in a professional and proficient manner to insure their needs were met.• Prepared weekly schedules for associates• Prepared and organized meetings and fundraising events• Associate of the Month 2002, 2005, 2007• Customer Service Leader 2008, 2009, 2010• Helped store achieve Overall Customer Satisfaction Score of 80%• Helped lead Men's Clothing to achieve number one sales gain in the district