**** * **** **

Tacoma, WA *****

Cell: 206-***-****

Email: adyp2e@r.postjobfree.com

CATHERINE JONES

OBJECTIVE: To ensure an administrative position that will utilize my people skills, team building efforts and will allow for unlimited future growth and challenge.

QUALIFICATIONS: Utilization review and case management experienced (USFHP)

Clinical Administrator Coordinator (United Health Group)

Twenty plus years experience of Managed care health plans and processing of all

incoming and outgoing referrals.

Communicate with patients, providers, specialists and insurance of an approved

and denied referral authorization.

Tracking and implementation of referrals

Problem solver in critical referrals situation including meeting with Medical Directors

Ability to multitask and prioritize work in an organizational manor

Strong computer skills and word processing skills

Work on deadlines and when necessary and very confident

WORK EXPERIENCE: 10/2020- PRESENT United Health Group (Optum)

Senior Clinical Administrator Coordinator

Reviews and processes all managed care patient referrals and clinical service requests by following established protocols, guidelines and medical necessity

Performs verification of eligibility on each referral request of managed care

Responds to inquiries from external sources for processing referrals and authorizing services to Managed Care patients

Follows up on all requests for information and documentation

06/2016-08/2020 USFHP (Pacific Medical Centers)

Referral Coordinator

Process all incoming referrals for denials and approval

Discuss all complex referrals and presenting in meetings

Acts as the insurance Liaison to the external Specialists and members

Educate members with benefit coverage and denials

Assure patients of understanding of in networks and non-networks Specialists

06/2015-06/2016- Triwest Healthcare Alliance

Team Lead Medical Management

Process all incoming referrals including reviewing escalated and complex authorizations

Supervision of multiple employees in my team

Auditing completed referrals including proper used of CPT codes and approved services

Training new employees as a Referral Coordinators

05/2011-09/2014 Swedish Medical Center (Imaging Dept)

Financial Counselor

Processing in house MRI’s, CT’s and all diagnostic test for authorization from

insurance companies

Prioritizing URGENT, and routine authorization request

Peer to peer overview with managed care insurance for referral authorization

06/2006-05/2011- St Francis Medical Clinic

Lead Referral Specialist

Processing all incoming and outgoing referrals

Ability to educate patients with medical coverage and resources

Knowledge of all managed care insurance, including third party, L & I, state

insurance etc;

Medical Assistant coverage when short staff

09/2001-06/2006 Community Health Centers of Federal Way

Referral Coordinator/Medical Assistant

Process all managed care referrals and educate patients with insurance

coverage and benefits

Coordinate with Specialists, insurance companies, and patients regarding their

authorizations

Front desk coverage for receptionist

EDUCATION: 1999-2000 Bryman College Seatac, Washington

Medical Assisting Diploma

Graduated on the Honor Roll

1995-1997 Nathan Hale High School Lake City, Washington

LANGUAGES: Fluently Bilingual in English and Filipino (Tagalog) can also understand Spanish

-REFERENCES AVAILABLE UPON REQUEST-

Contact this candidate