Medical Records Data Entry
Resume:
Lisa Calvert-Robinson
PROFESSIONAL SUMMARY
Medical Records Coordinator/Scheduler with 10+ years experience. Detail oriented with strong administrative skills. Strong problem resolution, customer service, filing, and database skills. Recent short term assignments but also longevity with past employers – 15+ years with Excel Care and 2+ years with Adventia Healthcare, Total Home Health, and United Healthcare. SKILLS
MS Office, Nurse Notes, Physical Therapy Notes, Occupational Therapy notes, Speech Therapy notes. Medical Social Worker notes, Labs reports, Hospital Discharge Records, Appointments, Scheduling, Inbound/Outbound Calls, Data Entry, Filing, Scanning, Medical Terminology, Medicare ADR Charts
PROFESSIONAL EXPERIENCE
WELLMED OPTUM (UHC) - SAN ANTONIO, TX DEC 2019 - SEPT 2021 UTILIZATION MANAGEMENT COORDINATOR
● Provides data entry, filing, tracking time frames and status of case files and mailing letters to patients and providers.
● Reviews denials and determines whether the decisions are retro / claims DOS or prospective DOS, and whether they are NCB or medically necessary. Sorts appropriately
● Monitors system approval queues and prints member letters, ensuring that all approvals are printed and mailed by end of business day
● Prepares envelopes and letters for mailing according the UM policy
● Receives appeal requests from health plans and/ or QIO, logs requests, researches and provides requested information
● Works with claims department to redirect claims related appeal requests
● Generates reports for analysis by department using the data entry system
● Assists with CMS organization determination reports as needed WAGGONER & THOMAS ALL – San Antonio, TX Sep 2018 – Aug 2019 Medical Records Coordinator
● Protect the security of medical records (HIPPA) to ensure that confidentiality is maintained.
● Review records for completeness, accuracy, and compliance with regulations.
● Retrieve patient medical records for physicians, technicians, or other medical personnel.
● Assign the patient to diagnosis-related groups (DRGs), using appropriate computer software.
● Experienced in receiving and making calls for scheduling appointments.
● Process patient admission or discharge documents. BRIT-TEX NURSING SVC – San Antonio, TX Apr 2018 – Aug 2018 Medical Scheduler, Medical Secretaries
● Schedules client appointments/visits according to care plans and staff availability.
● Maintain medical records, technical library, or correspondence files.
● Greet visitors, ascertain purpose of visit, and direct them to appropriate staff.
● Understands and adheres to established policies and procedures.
● Creates and maintains staff schedules.
● Contacts care providers and clients regarding day-to-day changes.
● Discerns client services required as outlined in agreements, urgent requests and care plans.
● Enters staff and client information in database and create schedules.
● Maintains staff and client database with dates and reminders of TB and/or Labs, client admission, client hospital admission and discharge.
● Managed calls regarding authorization
● Experienced in making follow up calls for authorization.
● Obtain, receive and verify requests for prior authorizations and ensure that they are administered properly.
● Keep medical staff in the loop about any delays or problems in obtaining authorizations. ADVENTIA HEALTHCARE – San Antonio, TX May 2015 – Apr 2018 Scheduler SN
● Answer telephones and direct calls to appropriate staff.
● Operate office equipment, such as voice mail messaging systems, and use word processing, spreadsheet, or other software applications to prepare reports, invoices, letters, case histories, or medical records.
● Maintain medical records, technical library, or correspondence files.
● Greet visitors, ascertain purpose of visit, and direct them to appropriate staff.
● Understands and adheres to established policies and procedures.
● Creates and maintains staff schedules.
● Provides staffing for sick leave, vacation, long term leave.
● Schedules client appointments/visits according to care plans and staff availability.
● Enters scheduling data, creates schedules.
● Contacts care providers and clients regarding day-to-day changes.
● Discerns client services required as outlined in agreements, urgent requests and care plans. 8. Enters staff and client information into database.
● Maintains staff and client database (e.g. CQA, dates and reminders of TB, client admission, client hospital admission and discharge).
● Maintains staff and client statistics, and reports. TOTAL HOME HEALTH – San Antonio, TX Jan 2012 – Feb 2015 Scheduler SN
● Answer telephones and direct calls to appropriate staff.
● Operate office equipment, such as voice mail messaging systems, and use word processing, spreadsheet, or other software applications to prepare reports, invoices, letters, case histories, or medical records.
● Maintain medical records, technical library, or correspondence files.
● Greet visitors, ascertain purpose of visit, and direct them to appropriate staff.
● Understands and adheres to established policies and procedures.
● Creates and maintains staff schedules.
● Provides staffing for sick leave, vacation, long term leave.
● Schedules client appointments/visits according to care plans and staff availability.
● Enters scheduling data, creates schedules.
● Contacts care providers and clients regarding day-to-day changes.
● Discerns client services required as outlined in agreements, urgent requests and care plans. 8. Enters staff and client information into database.
● Maintains staff and client database (e.g. CQA, dates and reminders of TB, client admission, client hospital admission and discharge).
● Maintains staff and client statistics, and reports. ALPHA NURSING & THERAPY – San Antonio, TX May 2007 – Sep 2011 Scheduler
● Answer telephones and direct calls to appropriate staff.
● Maintain medical records, technical library, or correspondence files.
● Understands and adheres to established policies and procedures.
● Creates and maintains staff schedules.
● Provides staffing for sick leave, vacation, long term leave.
● Schedules client appointments/visits according to care plans and staff availability.
● Enters scheduling data, creates schedules.
● Contacts care providers and clients regarding day-to-day changes.
● Discerns client services required as outlined in agreements, urgent requests and care plans. 8. Enters staff and client information into database.
● Maintains staff and client database (e.g. CQA, dates and reminders of TB, client admission, client hospital admission and discharge).
● Authorizations.
● Receive and verify requests for prior authorizations and ensure that they are administered properly.
● Consult with presiding or nurse managers to obtain clearance for the necessity of treatment.
● Look through insurance plans in a detailed manner and process required referrals.
● Sort medical records and submit them to the carrier in a bid to expedite the authorization process.
● Keep medical staff in the loop about any delays or problems in obtaining authorizations.
● Billed Private Insurance.
EXCEL CARE – San Antonio, TX Jun 1984 – May 2003
Scheduler
● Receive and verify requests for prior authorizations and ensure that they are administered properly.
● Receive and verify requests for prior authorizations and ensure that they are administered properly.
● Consult with presiding doctors or nurse managers to obtain clearance for the necessity of treatment.
● Look through insurance plans to process required referrals.
● Sort medical records and submit them to the carrier in a bid to expedite the authorization process.
● Keep medical staff in the loop about any delays or problems in obtaining authorizations.
● Schedules client appointments/visits according to care plans and staff availability.
● Enters scheduling data, creates schedules.
● Contacts care providers and clients regarding day-to-day changes.
● Discerns client services required as outlined in agreements, urgent requests and care plans. EDUCATION/CERTIFICATIONS
St. Philips College May
Certificate
College of Medical May
High school diploma
Theodore Roosevelt High School, San Antonio, TX
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