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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Coralthorn RoadMiddle River, MD Street Address
Cell #: PHONE NUMBER AVAILABLEEmail: r EMAIL AVAILABLEOBJECTIVE:Highly motivated and accomplished professional effective with administrative support skills to include customer service, problem solving of issues and complaints, multitasking and prioritizing. I am detailed oriented and a team player, who is seeking an opportunity to work in an environment that will allow me to contribute to the growth and success of the organization.EMPLOYMENT HISTORY:Case Management Utilization Review Specialist07/2012 - 02/2018MedStar Union Memorial Hospital201 East University ParkwayBaltimore, MD 21218Salary: $18.45 per hour, 40 hours/weekSupervisor: April Bessling (410) 554-2540* Review assigned denials and EOBs for appeal filing information. Gather any missing information* Review case history, payer history, and state requirements to determine appeal strategy* Obtain patient and / or physician consent when required by the insurance plan or state* Conducts medical records review and prepares clinical appeals in response to medical necessity denials* Gather and fill out all special appeal or review forms* Create appeal letters, attach the materials referenced in the letter, and mail them* Coordinate phone hearings with the insurance companies and the Medical Physician Advisors* Comply with all 1st, 2nd, 3rd, and External Level Appeal process.* Meet appeal filing deadlines by completing assigned work list tasks in a timely matter* Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager* Participate in team and appeal meetings by sharing the details of cases worked* Act as a backup on answering incoming telephone calls as needed* May undertake special projects assigned by the Team Leader or Financial Reimbursement ManagerMedical - Surgical Unit Secretary 04/2008 07/2012MedStar Union Memorial Hospital201 East University ParkwayBaltimore, MD 21218Salary: $15.75 per hour, 40 hours/weekSupervisor: Linette Ratay (410) 554-6459*Transcribing and data enter physicians' orders accurately and in a timely manner*Maintain communications between department personnel and other departments*Monitor the admission and discharges for bed availability*Recognizing and respond appropriately to emergency situations*Train new unit secretary staff members*Tracking and ordering supplies*Assisting other team members as needed*Assemble & dismantle patient medical record charts*Public contact with patients and visitors to assist or resolve issues through the tele-tracking and call-light system.Medical Review & Appeals Coordinator 03/2004 04/2008 Employer: Nationwide Better Health300 Clubhouse Road, #100, Hunt Valley, MD 21031Salary: $12.75 per hour, 40 hours/weekSupervisor: Darlene Fountain (410) 891-3300; company closed*Process medical necessity requests based on policies and guidelines in a timely and accurate manner*Administer denials and appeals requests according to URAC standards*Coordinate reviews with internal & external organizations for denials*Collect and analyze clinical documentation and notify parties of determinations*Process rate negotiations according to the insurance companys requirements*Assist the pre-certification department as needed.Medical - Surgical Unit Secretary 06/2003 09/2004 Employer: Greater Baltimore Medical Center6701 North Charles Street, Baltimore, MD 21201Salary: $11.75 per hour, 40 hours/weekSupervisor: Maurine McGinty (443) 849-2591: may be contacted*Performing clerical duties that include transcribing and entering physicians' orders accurately and timely*Maintaining communications between department personnel and internal supporting departments*Secretarial duties include answering several phone lines, coping, faxing and printing records*Monitoring the bed tracking board for admissions and discharges*Maintaining patients' medical records*Maintaining a courteous and professional manner in a high stress and quick moving environment*Recognizing and responding appropriately to emergency situations*Training new team members*Tracking and ordering supplies*Assisting other team members as needed.FEP Customer Service Representative 02/2003 03/2004 Employer: Care First Blue Cross Blue Shield1946 Green Spring Drive, Lutherville, MD 21092Salary: $11.50 per hour, 40 hours/weekSupervisor: Valerie Flowers (410) 561-4022; may be contacted*Receive inbound calls from patients or facilities to verify eligibility & benefits*Quote plan benefits based on coverage*Reviewed claims for denials of non-payment and re-processed the claims if appropriate*Provide assistance to members and/or providers regarding website registration and navigation*Process written customer correspondence and provide the appropriate level of timely follow up* Document all activities for quality and metrics reporting through the Customer Service Data Program*Maintain performance and quality standards based on established call center metrics including turn-around times* Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment*Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reductionPrecertification Coordinator / Therapy Technician07/1998 09/2003Employer: Spectera Healthcare2811 Lord Baltimore Drive, Baltimore, MD 21244Salary: $12.75 per hour, 40 hours/weekSupervisor: Chris Volkman (410) 265-6033: company closed*Obtain demographics to pre-certify patient for inpatient hospital services*Authorize therapy services based on specific guidelines*Request clinical for concurrent stay reviews and quote benefits based on plan coverage*Responsible for the accuracy of insurance information to determine financial responsibility*Develop and implement, in conjunction with management, workforce improvement strategies*Review accounts for accuracy to conform to State and Hospital criteria including referrals for the State & Local Agencies as well as Uncompensated Care Screenings*Specialized experience in coding inpatient medical records for final diagnosis using approved References guides*Train other medical record technicians in the proper procedures of codingCertified Nursing Assistance 04/1993 10/1997Employer: St Agnes Hospital900 Caton Avenue, Baltimore, MD 21229Salary: $10.75 per hour, 40 hours/weekSupervisor: Patricia Saunders (410) 368-2160; may be contacted*R eceive ambo emergencies and triage patient's (VS, specimen collection, EKGs, blood draws*Use of two-way radios to prepare the ER bay for ambo arrivals and to notify the nursing administration dept.*Assist patients with daily hygiene such as bathroom use, showers and brushing of the teeth*Provide assistance with feeding patients, ambulating, turning, and positioning patients*Maintain patient stability by checking vital signs and weight and recording intake and output*Maintains work operations by following policies and procedures*Protects organization's value by keeping patient information confidential*Serves and protects the hospital community by adhering to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standardsEducation:Doctors HelpPhlebotomy Technician Certification, 2014Rockhurst UniversityHow to Motivate, Manage & Lead a Team Certificate, 2006 (On-line Course)Baltimore City Community CollegePre-requisites Completed with 44 College Credits EarnedAutomation AcademyCertified Nursing Assistance Certification, 1992 - 1993Edmondson Westside Sr. High SchoolGeneral Studies High School Diploma, 1985 1989Computer Skills:Microsoft Office Suite, Outlook, Cerner, Allscripts, SMS, Telligen, Opti-Freight, Med-Connect, HPFAffiliations:Order Of The Eastern Stars MemberLicenses Motorcycle Rider |
