Stacey Fleming

580-***-**** • ad4sdi@r.postjobfree.com

Professional Summary

Dedicated healthcare professional with 29 years of experience providing exceptional quality of care and customer service to clients. Possess a high attention for details, am highly organized, task oriented and have extensive experience in managing personnel and departmental procedures. Seeking a full-time customer service position that enables me to use the qualities of active listening, empathy, problem solving, and communication that I have obtained throughout my career.

Employment

Case Manager for McKesson Corporation

Temporary Contractor with Remx through RSV season

7/5/2023 to 2/23/24

Worked with healthcare providers and patients to assist with appeal and management for claim denials

Worked with physicians and payers to advocate for product specific coverage

Communicated product benefits and efficacy to positively influence payer policy

Monitored drug coverage policies for multiple payers

Reviewed case outcomes to analyze and identify findings for client reporting

Conducting external research to identify appropriate alternate funding sources where insurance was not available

Ability to effectively escalate issues and complex cases referred from other reimbursement employees or manufacture representative

Created Prior Authorizations and Appeals as well as monitored their ongoing status

Inbound/outbound calls to patients, providers, insurance companies, and specialty pharmacies

Teladoc

Temporary Contractor with NexRep

05/22/23 to 08/31/2023

Researched and confirmed insurance benefits for routine and complex cases

Documented escalations and assigned departments in in which to follow-up

Assisted clients with enrollment into Teladoc virtual visits platform

Troubleshooting routine electronic issues encountered on Teladoc application and website

Intake of medical history to complete electronic enrollment

Performed electronic scheduling for provider visits

Physical Therapist

Orthopedic and Neurological Rehabilitation

DEC 2020 to APR 2022

Developed and implemented individualized treatment plans for clients with complex musculoskeletal injuries, resulting in increased mobility and improved quality of life

Communicated with Physician, Nursing, and Therapists on the progress of each client to ensure positive continuity of care across all disciplines

Obtaining pre-authorizations, letters of medical necessity, and filing claim appeals to provide necessary services for each individual client

Communicated directly with third-party insurance payors including traditional Medicare, Medicaid, Aetna, Humana, United Healthcare, BCBS, etc. concerning medical necessity of care and continued services

Medical scheduling management for multiple therapy staff

Ergonomics/Quality Monitor

Texas Recreation Inc

Contractor

JAN 2020 to DEC 2020

Conducted ergonomic assessments to identify potential risk factors for musculoskeletal disorders in the workplace reducing injury by 90%

Provided education on injury prevention, exercise, posture and ergonomics

Implemented quality control measures to ensure product quality standards were met

Identified and reported defective parts or components to supervisor to ensure quality products

Developed and maintained a database of quality control information, allowing for real-time access to quality data

Clinical Supervisor

Vista Living Skilled Nursing Center

APR 2016 to DEC 2019

•Direct communication with third party insurance payors including private insurance, Medicare, and Medicaid

•Active role in medical bill processing, appeals and resolution of delinquent accounts

•Directly administered, calculated and submitted MDS data sheets to CMS

•Assigned ICD-9 and ICD-10 diagnosis and procedural codes for max reimbursement

•Management and Supervision provided for Physical, Occupational and Speech Language Pathology therapies as well as ancillary staff

•Performance improvement conducted including routine chart auditing and staff productivity management.

•Onsite education to nursing, certified nursing aides and support staff

•Developed and streamlined documentation and exercise protocols for cognitive and physical rehab purposes

•Additional role included for Recreational Therapy to improve residential quality of life

Education

Bachelors of Science, Texas Tech University Health Sciences Center, Physical Therapy, Lubbock, Texas

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