Sheryl McGill

Looking for a position where I can utilize my many years of experience

Pittsburg, CA 94565

ad38g6@r.postjobfree.com

+1-925-***-****

Seeking a challenging career where my professionalism will contribute to the overall success and growth of the company.

Authorized to work in the US for any employer

Work Experience

Care Coordinator

Chinese Community Health Care Association - San Francisco, CA September 2022 to February 2023

Received phone calls from physicians offices, facilities, health plans and members in regards to Authorizations for inpatient,outpatient, surgery centers, skilled nursing facilities for services to be rendered. Verified eligibility, obtained demographic information for scheduling of prior inpatient or outpatient surgeries.

Generate of letters after decisions by RN, Medical Directors or Comenittee of Dortors. Prepared cases that RN sent for review.

Handled pend lists, and list that required additional information. List on TAT ( Turn around time).

Authorization Specialist

Brown And Toland - Oakland, CA

September 2019 to February 2020

Entering authorizations and processing requests for inpatient and outpatient services. Heavy phone calls from physicians and facilities.

Completing and following up with physicians office and health plans to complete authorization process before services were rendered.

Sending letters of decision make by Authorization Review nurses Medical Directors . Logging decisions.

Assisting RN with phone calls for additional medical or demographic info that us needed to complete authorization request.

Lead Authorization Representative

Hill Physicians Medical Group - San Ramon, CA

January 1997 to January 2019

• Responsible for processing electronic requests that were received from provider offices are received via fax (FAXCOM), electronic submissions, mail, voice mail or telephonically.

• Reviewed clinical data matching it against specified medical terms and diagnoses and follow established procedures for authorizing request.

• Assisted in verifying that all incoming authorizations were current enrolled member within the Medical group. If needed was responsible for sending all member's information to verify for eligibility purposes to eligibility dept.

• Accountable for completing yearly required HIPPA, Cultural Awareness, Fraud, Waste, and Abuse compliance courses.

• Trained new employees held to those standards defined within the operational manual and training manuals.

• Performed audits on employees in accordance to the general process of completing authorizations within and between department and staff rolls.

• Responsible for working assigned tasks in the Prior Authorization queue and other assigned reports. Education

Associate in Arts (AA)

Los Medanos College - Pittsburg, CA

September 1975 to June 1977

High school diploma or GED

Skills

• Microsoft Outlook

• Epic

• Special Education

• EMR Systems

• HIPAA

• Medical Terminology

• Medical Records

• Autism Experience

• Experience with Children

• Teaching

• Conflict management

• Supervising experience

• Developmental Disabilities Experience

• ICD-10

• Medical Billing

• Insurance Verification

• English

• Medical office experience

• Microsoft Office

• Customer service

• Microsoft Excel

• Computer skills

• HCPCS

• Typing

• Communication skills

• Organizational skills

• Analysis skills

• Medical coding

• Windows

• Data entry

• EHR systems

• ICD coding

• Anatomy knowledge

• Microsoft Word

Assessments

Medical billing — Completed

January 2022

Understanding the procedures and forms used for medical billing Full results: Completed

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

Additional Information

Skills

• Excellent oral and written communication skills

• Detail oriented and highly observant

• Ability to multitask

• Medical Terminology

• Maintain professional demeanor

• Many years in healthcare field.

• Special Education

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