UM Specialist/Intake Counselor

MaryFrances Fitzgerald

Stroudsburg, PA ***** 732-***-**** **********@*****.***

Enthusiastic and organized human services professional with extensive experience in behavioral health and substance abuse services. Exceptional ability to manage staff training and activities in busy environment with patience and expertise. Possess a combination of client management, team leadership, and information technology skills. Demonstrate excellence in report writing, meeting deadlines, and scheduling. Extensive knowledge of DSM-5 and assessment tools specific to mental health population.

PROFESSIONAL EXPERIENCE

POCONO MOUNTAIN RECOVERY CENTER, Henryville, PA 2016 - Present

UR Specialist, 2017 - Present

Develop and maintain contact with managed care providers to ensure continuity of care for clients, as well as the reconciliation of claims. Facilitate staffing, including clinical directors and treatment coordinators, in order to problem-solve difficult client cases. Provide the same services for sister company, Huntington Creek Recovery Center.

Accomplishments:

Complete and submit clinical concurrent reviews to insurance providers for continued stay authorization.

Analyze patient records to determine legitimacy of admission, treatment, and length of stay in order to stay compliant with government and insurance company policies.

Determine criteria concerning admission, treatment and length of stay of patients by analyzing insurance, governmental and accrediting agency standards.

Continue behavioral health training through monthly classes to stay up to date with state and county licensing expectations.

Patient Financial Counselor, 2016 - 2017

Worked alongside patients to explain their personal financial information and determine their ability to pay for services. Assisted with financial aid applications and provided education on available financial assistance programs. Collected payments and set up payment arrangements as needed.

Accomplishments:

Interviewed patients to gather accurate demographic and financial information, while continuously documenting all correspondence.

Helped patients understand their insurance coverage and how it pertains to their billed services, while negotiating payment plans with patients and insurance companies.

ENDEAVOR HOUSE, Keyport, NJ 2011 - 2016

Intake Counselor, 2013 - 2016

Collaborated with directors to ensure staff provided a welcoming and informative experience for new intakes. Conceptualized and implemented staff training sessions to foster a professional delivery of services to patients and a precise reporting of contacts and treatment delivery.

Accomplishments:

Executed the position of Director in a flawless manner when called upon during his absences.

Expertly resolved critical issues while delivering projects and reports in a timely manner.

Recognized for quickly adjudicating insurance treatment authorizations for new admits.

Intake Coordinator, 2012

Positioned as liaison and coordinator between referral facilities and hospitals. Helmed insurance pre-certification duties and ensured all documentation was correctly and timely filed.

Accomplishments:

Revised and implemented pre-screen eligibility assessment for improved patient response and more accurate reporting, as well as charged with monitoring all data input for new patients.

Explored new techniques for family and financial counseling, resulting in positive patient feedback.

Front Desk Manager, 2011 - 2012

Appointed to control all activities at reception desk, including guest visits, staff check-ins, and patient referrals.

Accomplishments:

Created new, more efficient system for collecting and recording co-pays and scheduling appointments.

Received accolades from patients and family members for fostering a welcoming environment for new admits.

SKILLS

Problem Resolution

Relationship Building

Motivational Leadership

Program Management

Goal Setting

Staff Training

Process Improvements

MS Word/Excel

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