Post Job Free

Resume

Sign in

Patient Care Utilization Management

Location:
Charlotte, NC
Salary:
45,000
Posted:
November 20, 2023

Contact this candidate

Resume:

Danielle L. Burke

Davidson NC 305-***-****

ad1bmn@r.postjobfree.com

Profile

Office and medical administrative specialist with experience in all aspects of clerical duties and functions in a medical setting-from level 1 hospital trauma center to to private practices, whose extensive patient care expertise as a hospital secretary, admitting/discharging patients according to instructions and procedures, directing inquiries to the proper source/professional, documenting medical records, accurately and cost effectively billing medical services; coupled with direct assistance to physicians and nurses instructions and pre-authorizations for procedures, helps improve service delivery, retain and expand patient base, and increases market/brand presence, sales and profits while adhering to policies and regulations. As well as hiring, scheduling, and orienting, and supervising RN and LPN staff.

Employment History. WDRB. 07/12/2023-Present Scheduler Scheduling meetings for the producer

Gonzalez Auto Center 11/2018- 5/24/2023 Secretary Answer phones, take messages, greet customers, write up (or input) invoices for service work, handle the mail, do the filing, pay bills, order supplies for the shop, make coffee, make sure vending machines are full/serviced, type and send any letters or invoices as needed.

Prestige Healthcare

1/2015 – 5/2016 Utilization Management Technic Miami, FL

My position responsible for coordinating, generating and tracking both incoming and outgoing correspondence, faxes and authorizations related to prospective, concurrent and post service review functions. I also with facilities, vendors, providers and other staff to facilitate the receipt of information and records for prompt review and response. It is also the duty of this position to monitor compensation plans for physicians, licensed nurse reviewers, staff and consultants who manage and conduct the medical management determinations

my duties include. Suppor the daily operations of Utilization Management, Concurrent Review, Retrospective Review and Prior Authorization teams through interaction with staff, facilities, vendors and providers.

Maintains a current knowledge base of Utilization Management processes and timelines. Processes all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines. Refers as appropriate to clinical team members for review as defined by workflow. Perform in a call center environment appropriately processing or triaging calls from providers Creates, updates maintains and/or closes authorizations for services as assigned within process guidelines. Perform clerical responsibilities such as processing urgent scanning/mailing requests, document/record archival, document/record retrieval, interact with the Department of Public Welfare, database data entry, database reporting and the ordering of supplies. Participates collaboratively with business partners to obtain, track, and report information as needed for corporate and/or regulatory reporting. Maintains current knowledge base in PHC systems and programs to appropriately document case activity. Comply with Prestige Health Choice and HIPAA confidentiality requirements and ensures protection of member personal health information

Nursing Station Clerk/Patient Access (Temp to Permanent)

09/2009 – 1/2015 Upstate Medical Hospital Syracuse, NY

Refer incoming calls and messages

Record preparations; receive new admissions and initiate patient medical services

Prepare and maintain patient charts, maintain a daily log and clinic log.

Process physician and nursing staff orders

Input of patient registration and other relevant information into hospital computer system

Make emergency calls; and perform miscellaneous clerical duties as required.

Hair Stylist

07/2008-09/2009 Trade Secret Hair Salon Syracuse, NY

Performed a wide variety of hair stylist duties including straightening; conditioning; bleaching; tinting; cutting; blow drying; coloring; styling; applying perms; weaving hair with products and solutions.

Secretary

07/2008-12/2008 CNY Neurology Syracuse, NY

Answered the doctor’s office phones

Signed people in and out

Set appointments

Checked authorization for insurance

Confirmed appointments

General Accounting (Bookeeping)

Client Service Specialist

09/2004-02/2006 Nurse Core Syracuse, NY

Recruited, screened and interviewed potential nursing staff.

Interpreted policies and procedures, as well as W-4/ I-9 paperwork to newly hired employees during orientation.

Resolved client grievances, avoiding potential withdrawal of client facility needs

Conducted verbal and written counsels and discharge interviews.

Administered background check fingerprinting, background on-line searches, employee photo identification.

Verified on-line the authenticity of C.N.A. certificates and L.P.N, R.N. licenses.

Staffed nursing facilities, hospitals, doctor's offices, and residences

Answered multiple phone lines and data entry.

Reservationist/Sales Rep

Marco Polo Beach Resort 04/2002-01/2004 North Miami Beach, FL

Negotiated allotment to contractual agreements with travel agents and on-line sites.

Resolved guest complaints and made guest reservations

Compiled daily close out audits.

Assisted management staff with preparing reports for executive meetings.

Made sales calls gaining corporate accounts with local business offering corporate rates.

Room Service Supervisor

09/2000-02/2002 Dadeland Marriott Miami, FL

Supervised room service staff; provided a multitude of services in a timely and professional manner.

Increased room service effectiveness through implementing an organized productive system

Generated revenue which increased our scores from 50% to 80% effective.

Distributed daily employee gratuity.

Performed daily end of the day audits; and wrote reports on guest complaints which were reviewed in executive staff meetings.

Education

Hoosac Preparatory High School

Hoosac, NY 06/1994 GED 1995

Occupational Training/Certification

Phillips Hair Institute, Cosmetology License Syracuse, NY 05/2008

Skills Set

45+WPM

Computer proficient in Micro-Soft products, Well-Software, EPIC software and other data entry systems.

Patient care specialist with active listening skills and extensive knowledge of medical terminology and practices.

Leadership skills; team work ability

Knowledge of HIPPA and OSHA regulations.

Sales/Customer service experience. Personal Reference: Edward Duchene 305-***-****



Contact this candidate