| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLE
HEALTH INFORMATION PROFESSIONAL
Healthcare experience as Surgical Coordinator, for all types of thoracic procedures, ie CABG, AVR, MVR, AAA, and MAZE procedures just to name a few. Known for dedication to providing premium provider relations. Skills include:
__ Precertification/Imaging
__Authorization/Inpatient/Outpatient procedures
__Insurance Specialization
__Diagnosis codes specialist
ICD10-
CPT codes CABG, AVR, MVR
All procedures for thoracic surgeries
__Medical Billing & Coding
Medical Records Management
Provider Data Entry
Hospital, Facility Data Entry
Bookkeeping & Filing
__ HIPPA Knowledge
__ Contract interpretations
__ System Configuration
__ Compliance CPT/Diagnosis
__ Strong Analytical and Research Skills
__ Extensive Knowledge in Claims Process, Procedures and Guidelines
Patient Scheduling
Ancillary Testing
Patient Education
HIPAA & JCAHO Knowledge
Education
High School Diploma, Buchholz High School 1982 Gainesville, FL 32607
Professional Experience
Savannah Vascular and Cardiac Institute
4750 Waters Ave, Ste 500
Savannah, GA 31404
Surgical Coordinator 10/19/2015-03/01/2017
Scope of Position
To effectively, efficiently, and fairly distribute new patient referrals to physician medical staff, schedule returning patients to appropriate physician, schedule patient surgeries, and set in motion systematic, friendly patient care.
Checks new patient referral numbers for managed care plans, current insurance data and identification. Documents new patient referral data on appropriate form. Enters the demographics into the computer system. Assembles all medical information related to the patient for the purpose of creating the medical chart. Obtains patient medical records from referring physicians and has the nurse review the records before the patient is seen. Schedules surgeries accurately and timely and determines that pre-certifications for surgery are being completed. When appropriate, explains surgical consent and gives instruction for preoperative process. Audits work regularly to determine that patients have been scheduled with the appropriate physician. Special Skills Basic computer skills,
Intergy, multi-line telephone system, voice mail, medical terminology, insurance documentation, and ability to time line appointments. Excellent oral communication skills, organizational skills and attention to detail.
Scheduling inpatient surgery
Once the physician has seen the patient in the office and surgery has been explained and patient is in agreement to have the surgery, a task is sent to me via NextGen or by phone. At this time I will contact patient about timeline to schedule surgery. Usually we schedule within a week or so of the patient s office visit.
I will then run the patients insurance, determine if preauthorization is required. Confirm that we accept the patient s insurance. If precertification is required, I will begin the process of obtaining the authorization by way of online submission or verbal. I will write the order for the specific procedure. Create Operating room posting sheet. Compile the office note, testing, and any other documentation that is pertinent to the case.
Contact PST- (presurgery testing) get appointment date for the patient to have preoperative testing specific to the case. Give patient date and time of appointment with PST and give location of PST. Fax orders, office notes, and testing to PST.
Contact the OR @MHU, get the procedure scheduled, give specific instruction of what needs to be in the OR room at the time of surgery. These are specific to each provider, and procedure. Give them cpt codes, ICD 10 codes, how much time is needed for the procedure, who the surgeon is, who is assisting if any.
Schedule any additional testing prior to surgery, stress testing, CTA s, lab results and imaging verify that all the results are in NextGen for provider to review prior to surgery.
Contact patient s cardiologist for cardiac clearance if requested by provider.
Contact any and all representatives that will need to be in procedure for ex: rep from Medtronic, Boston Scientific, AtriCure, Edwards, and Endologix, contact and set up with perfusion, anesthesiologist, arrange for any other types of specific products that will be required for completion of procedure.
Review patients medication to see if patient will need to stop or hold any medications prior to procedure. This information will also be noted on the procedure order. Discuss with patient about medications to hold, answer any questions that they may have if I cannot answer, Cindy will contact. Give instruction for what to do or not do night before surgery, let them know where to report morning of procedure and time.
Schedule the patient in NextGen, providers Outlook and in providers note book. Put all information in the appointment detail box.
Imaging and Referrals
Providers request high tech radiology prior to seeing a patient in the office. Patients that are coming in to be seen for AAA s, thoracic aorta aneurysm and others may need to have CTA s chest, abdomen and pelvis so that the provider can review prior to office visit. This assist in the provider determining what kind of surgery patient will need, if they need surgery.
Established patients will have periodic or annual imaging to review aneurysm, status. A system is in place by month to schedule and scan results in the NextGen system for providers review.
CTA, CT, carotid ultra sounds, MRI s any kind of high tech radiology. I send the order to appropriate location, with authorization if one is required. Scan in results and send to provider for review.
Referrals are created some times in NextGen, some can be verbals from the provider. I send the order, patient demographics, insurance information, most recent office visit. These are faxed out by me and verified by me that they have been received and the patient has been scheduled. Maintain up to date information with referrals, to insure resolutions have been completed.
Cardiac and Vascular Institute
Wellspring Management Services, Inc
4645 NW 8th Ave
Gainesville, FL 32607
Precertification/Authorizations/Verification Insurance 06/07/2012-07/25/2015
Scope of Position
Precertification department is responsible for obtaining authorizations for many different testing and procedures. I make sure that insurance is put in the system correctly, Eligibility is verified. Review patient records for medical necessity and verify that we have the proper cpt codes and diagnosis codes. Maintain all websites that we use for the authorization process. If the insurance does not have a website then we just call. Document all verbal and printed authorizations including but not limited to, BCBS/AvMed/Cigna/Aetna/Humana/Medicaid/ workers comp and other misc types. Work closely with the scheduling department to insure all authorizations are obtained prior to the patient coming in. Assign peer to peer reviews when it is necessary, with our ARNP staff. Correspond with the doctors if a certain test or procedure has been denied, that they have requested. Overall make sure that we have the authorization in place so that we get paid.
I am responsible for authorization for Cath s/surgical procedures/ peripherals/ venous ablation/ SPECT/PET scans and echocardiogram / Thoracic procedures: /Aortic valve replacements/ CABG, and mitral replacement/repair/lobectomy and more.
Insurance verifications/clarifications/make sure we are in network. I also have trained the staff on how to understand and read benefits. To know the difference between medicare and medicare replacement plans.
Verify/ input authorizations in system/ scan documents into Intergy. Attach referral to the actual appointment so that the auth number is visible.
I am the liaison between the doctors and insurance companies/. This can be in a number of ways to help get certain test or procedures authorized by communicating with the doctors what need to be addressed in the office notes to assist in the process of getting approvals. I schedule peer to peer with doctors and arnp s when appropriate.
Respond to all calls coming in for add on same day testing, if auth is required, I obtain it.
Build referrals to track testing authorizations and build referrals to track all HMO/Compass/Tricare policies that require an authorization from the PCP to be seen by a specialist.
AvMed Health Plans
Provider Data Professional 1999-03/12
Scope Of Position
The Provider Data Professional is responsible for building and updating all provider contractual agreements, and demographical information for the provider network in all geographic regions. This positions builds and maintains the code set alignments that enable member assignment, claims payment, accurate Web (online) and paper directories, resolves provider issues for pending claims and maintains configuration for EDI claims submission for Hospital, Hospital based physicians, Primary Care Physicians, Specialty Care Physicians and other Healthcare Professions. This position also assists with Federal/State statue reporting, accreditation audits and 1099 submissions and performs front end triage on provider request for assistance.
Essential Job Functions:
Build and update participating physicians/facility contractual agreements within the provider and claims payment system.
Responsible for continuous maintenance on all provider data for designated and specific delegated provider groups. Performing liaison duties between the delegated provider and AvMed.
Perform verification of licensure, board certification, and validation of NPI (National Provider ID) numbers.
Research/resolve claim pended for provider configuration and/or payment issues to including communication and collaboration with pricing and claims on system resolutions as well as with other appropriate internal personnel on claim reviews when necessary and specifically in cases where education or training is required.
Build provider IRS reporting and payment methodology for claims payment and 1099 reporting.
Examine contract to ensure reimbursement and contract integrity. Communicate any issues with appropriate personnel and coordinate any required corrections.
Perform any special projects related to provider data within a timely manner, documenting and reporting back to management status updates.
Prioritize outbound provider inquiries regarding TAX ID changes, claim payment issues, contract configuration and credentialing status.
Assure Provider network configuration meets all regulatory requirements, to include NCQA, CMS, AHCA, DOFS, etc., which includes working with Medical, Claims, Member Service and Finance Departments.
Educate and/or train contracted providers on use of the Web directory, i.e. PIN numbers, verifying eligibility and checking claim status.
Super user for Software conversions and/or upgrades.
Assists with interdepartmental training on new system configuration and product developments
Ability to organize and prioritize daily work and special projects to ensure timely completion.
Recognizes and observes all company and departmental policies and procedures.
Focuses on achieving departmental and organizational objectives.
N & J Paint and Body 1996-1999
Scope of Position
Accounts/Payable, receivables, payroll, deposits, vehicle insurance audits, order parts, take in vehicles for repairs, painting and body work. Assigned work out to body men and painters. Responsible for final inspection of vehicles. Schedule vehicles in and out.
Personal references available upon request. Letters of Recommendations are attached |
