Medical Service
Resume:
MICHELLE FLORES-LAWSON
*** ******** ****, *** *****, CA 94565 H: 925-***-****
Professional Summary
** ***** ******* **** ********** to include management skills/functions
such as planning, scheduling, Organizing, and tracking process, ensuring
the feasibility of the project and its objectives.
Skills/ Highlights: Electronic medical record, Word Excel, Power Point,
Medical Coding & Billing and management experience
Professional Experience
Clinic/Procedure Coordinator- Bay Area Pediatric Pulmonary -6/14 -Present
Schedule inpatient and outpatient surgeries, Schedule appropriate
diagnostic testing and follow up, Complete appropriate insurance
authorizations including writing predetermination and appeal letters to
various insurance companies, Provide cost estimates to patients for
upcoming surgeries, Schedule patient appointments and manage the
physician's schedules, Provide assistance to patients in regards to
preparing for surgery by answering questions and addressing concerns. Work
closely with the physicians, team of physician and hospital surgery staff.
Scheduling, coordination of follow up appointments.
Health Plan Authorization Technician -Contra Costa County Health Plan
Martinez - 12/10-6/14
Receive and enter prior authorization requests for medical services, as
well as retroactive authorization, inpatient hospitalization, and appeal
requests while assigning ICD-9 and CPT codes for review of medical services
and procedures, respond to providers, members, claims, and member services
inquiries. Review incoming authorization and appeal requests to determine
if supporting documents are submitted or available for a nurse or
pharmacist for clinical review and make a decision or to request additional
information as needed. Verify member eligibility, prepare and process
California Children's Services applications accurately code each requested
service and procedure. Process authorization requests within established
timeliness standards. Assist with determining if requested services are
within the member's scope of benefits, if prior authorization is required,
and if the requested service requires clinical review for medical necessity
by a Registered Nurse or Pharmacist or the Medical Director.
Medical Office Associate- Children's Hospital Oakland -6/08-12/10
Greet and registers patients Receive patient co-payments, answers questions
Directs families to other inpatient and outpatient locations Gathers
demographic information Provides appropriate forms to patients Maintains
and develops knowledge of managed care Consent and insurance issues Answers
phones, routes callers, relays messages and Reconcile daily monetary
transactions.
Workers Comp Liaison- Muir Orthopedics- 8/07-5/08
Conducted Worker's compensation billing audits. Prepared medical billing
and coding, monitoring. Worker's compensation case management and.
Coordination of patient care, reviews medical records for documentation and
billing.
Service Unit Manager -Kaiser Permanente Walnut Creek, CA -10/98-8/06
8 years' experience in health-care management and human resource
development Worked closely with Insurance carriers to ensure continuity of
patient care Developed plans and policy changes Tracked data using Access
and Excel to prepare department reports Maintained and updated staff
development as well as departmental Policies and Procedures Daily
supervision of departmental operations and medical support staff to include
staffing Conducted new employee orientations and staff development
trainings HR Law and Benefits experience that includes recruitment and
staffing Acted as Explanation of Benefits Coordinator Worker's Compensation
case management and ICD-9 coding and billing experience Quality control
audits and compliance for medical facility (JACHO/HIPPA Laws compliance.
Internal/external authorizations for medical services Effective
communication with Employer/Client Groups Monitored staff production to
ensure proper work flow Utilization review/Workers Compensation Liaison
and in-service.
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