Community Liaison Prince Georges
Resume:
Carla Arrington
White Plains, MD *****
adr0ul@r.postjobfree.com
Highly motivated client focused healthcare professional with over 28 years of extensive experience in healthcare. Currently seeking a management position where I can utilize my strong leadership skills, with the ability to work well with others. Exceptional organizational skills, able to manage multiple projects and meet deadlines.
Work Experience
Director of Business Development
PHR, Inc - Annandale, VA
2010 to 2022
• Coordinate and perform duties of business development to key healthcare outlets
• Communicate potential risk management/challenges with potential referrals
• Provide recommendation on new policies and changes to the existing policy to improve patient care, increase performance of staff, and increase revenue for the organization.
• Review and analyze personal and departmental budgets based on reports generated and provide feedback
• Collect and analyze data to report critical information via oral and written communication as required by law to ensure continued healthcare services
Community Liaison
• Communicate with hospitals, Skilled Nursing Facilities, and Physicians to facilitate homecare services
• Review/verify patient eligibility as it pertains to Medicare regulations
• Formulate yearly business plan for all accounts
• Market company services via In-service and community activities
• Develop and maintain relationships with referral sources
• Expand business contacts within my territory in order to increase revenue Home Recovery (Americare)
March 2020 to July 2020
Account Manager/Physician Account Mgr
MEDSTAR HEALTH/VNA - Calverton, MD
August 2006 to February 2010
Market home infusion/Homecare needs to physicians/hospital facilities
● Maintained key accounts in the Baltimore/Prince Georges' region
● Facilitated discharge planning needs
● Maintained relationships with physicians/hospital personnel Clinical Liaison
MID-ATLANTIC HEALTHCARE - Owings Mills, MD
April 2004 to June 2006
• Managed key accounts in the Washington DC/Baltimore areas including hospitals, and doctor's offices.
• Market durable medical equipment and home infusion
• Facilitated discharge planning, and home setup of DME/home infusion by collaborating with case managers/social workers on a daily basis
• Coordinate in-service programs including Healthy Steps Respiratory assessment and COPD program Health Services Coordinator
D.C CHARTERED HEALTH PLAN - Washington, DC
2002 to 2004
• Process request for Pharmacy Overrides (Advance PCS/Grubbs)
• Resolve all suspended claims for payment
• Track/Resolve all Appeals and Grievances
• Pre-authorize elective surgeries utilizing M&R/Interqual
• Refer cases to Case Management
• Track all high cost members for monthly ING re-insurance
• Provide training for all UM staff
• Verify coverage and benefit of all members
UM Specialist
• Triage all incoming calls for referrals and pre-certification.
• Route calls appropriately from facility UR nurses to UM Coordinators.
• Obtain/Input demographic information into MHC according to Health Plan policy.
• Counsel, problem solve and educate callers on insurance benefit questions, certification status, and other HMO requirements.
• Collect data for analysis of all UM monthly reports and statistical files.
• Monitor and track all inpatient stays for admission and discharge dates.
• Negotiate current contract rates for DME equipment.
• Daily oversight of Appeals and Pharmacy override. Healthcare Facilitator
AETNA US HEALTHCARE INC - Largo, MD
1998 to 2002
• Intake/Triage incoming healthcare ACD calls.
• Authorized inpatient and outpatient care, including home health care and follow-up for HMO members
• Determine medical necessity (using ISP/Interqual).
• Collate/maintain OBGYN records.
• Advise providers of approved authorization numbers/services.
• Contact assigned hospitals for retrieval of new admissions.
• Verify discharges and confirm elective scheduled admissions.
• Provide facilities with benefit information related to co-pays/coinsurance and assigned LOS if applicable. Education
some college in Health Services Management
University of Phoenix
Skills
• SKILLS- Excellent communication, interpersonal and organizational skills In-depth knowledge of medical terminology Windows Vista, XP, Macintosh, in marketing and networking through Facebook and Twitter. Outlook, Microsoft office suites
• Employee Orientation
• Recruiting
• Case Management
• Managed Care
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