Mental Health Data Entry, insurance verification, clinicalrecords revi
Resume:
Linda Edmisten
*** * ********* **. ****** Arrow, OK. 74011
*****.********@*****.***
OBJECTIVE
Customer-focused representative with a proven capacity to troubleshoot issues in order ensure customer satisfaction. As a self-motivated and organized individual, I am looking to be part of team where my high-performance standards can be utilized as well as my independence.
EDUCATION —
EXPERIENCE
Tulsa Community College
Associates in applied science.
2018-Current
Sapulpa Technology,
LPN 2007
Sapulpa Central Tech
GED 2005
02/01/2021-Current
Utilization Review Specialist• TCBH
Review the medical records of all observation and medical admissions to determine the medical necessity for admission and continued stay • Continues review of all patients using criteria and determines need for continued hospitalization based upon third-party payer/insurance guidelines • Based on third party payers/insurance guidelines, communicates as required for continued stay review. May include phone, fax, and payer website (i.e. Availity) • Working knowledge of severity of illness and intensity of service factors to determine alternative levels of care • Advocates for the patient and hospital with third-party payers to secure appropriate payment for services rendered • Prevents denials and disputes by communicating with third-party payers and documenting relevant information. Files for inpatient and observation appeals because of third-party payer denial or obtaining authorization • Establishes and maintains effective communication with all referral sources, insurers, vendors, and patient supplier systems • Interacts, communicates, and intervenes with multidisciplinary healthcare team in a purposeful, goal-directed fashion. Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization and discharge planning • Collaborates with the social worker to proactively identify the need for Patient and assist with resources.
11/18/2019-2/01/2021
Staffing Coordinator • Brookhaven Hospital
Assessed, prioritized and handled multiple tasks• Recruit, interview, and hire Mental Health Technicians • Maintain the schedules of the Mental Health Technicians and RN/LPN • Approve/Deny vacation per policy •Fill-in as a Mental Health Technician when needed • Answer phones, data entry, filing, scanning, copying, etc. • Provide outstanding customer service • Assisted the DON with scheduling meetings with Staff • Scheduling staff for training such as CPI, CPR, Onboarding, Food handlers permits, and Human Resources Orientation • Schedule Transports for patients appointments • Tech CPR • Provide a daily report to DON and CCO of facility’s Hours per patient per day according to the needs of our Intensive supervised patients • Report an extensive Excel spread sheet on hours excluded through nursing hours • Track, Trend and reduce overtime.
7/31/2012-11/18/2019
Lead Mental Health Tech • Brookhaven Hospital
Perform patient care responsibilities considering needs specific to the standard of care • Assure admission and discharge checklists are completed as assigned • Thoroughly check each patient’s person in order to confiscate contraband and ensure each new patient is oriented to the unit rules, patient bill of rights and responsibilities • Performs observational rounds every 15 minutes for suicide and seclusion checks per policy • Continuously observes significant behaviors, actions and activities of the patients. Document’s observations in the patient’s charts, reflecting implementation of the treatment plan. Reports any unusual occurrences. • Facilitate the goal groups, skill streaming groups, team building and various life skills and independent living skills groups. • Monitor and provide verbal de-escalation or Crisis intervention when patient is harm to themselves or others.
KEY SKILLS —
COMMUNICATION
Proficient in Microsoft Office
2 years call center Exp.
CPR Instructor Exp. 2021
Safe Driver
Training
Logistics Knowledge
Data Entry: 10 Key
HIPPA
OSHA
Scheduling for 100+ staff
CPI Training Exp. 2021
Excellent Phone Etiquette
Work motivation
Proficient (Assessed 2021)
Customer focus & orientation
Expert (Assessed 2021)
Recruiting
Proficient (Assessed 2021)
Work style: Conscientiousness
Expert
Medical terminology
Proficient (Assessed 2021)
Work style: Perseverance
Highly Proficient (Assessed 2021)
Work style: Reliability
Highly Proficient (Assessed 2021)
Attention to detail
Highly Proficient (Assessed 2021)
REFERENCES
Janice Ponds; M.A., LADC, CBIS; DIRECTOR OF UTILIZATION REVIEW 918-***-**** ******@******************.***
Judi Hamilton: Southern Landscapes
Owner/Founder 918-***-****
Angela Henson: MHT Brookhaven Hospital
Karen Lacey: LPC
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