Driven and compassionate healthcare professional with 23 years of experience within the Health Care industry, ranging from Medical Billing; Managed Care and Case Management roles for hospitals, clinics, and nursing homes. Strong decision maker / problem-solver with excellent time management skills. Accountable and responsible with strong focus on patient wellness. Extensive experience and knowledge of contracts with commercial insurances and medicaid plans for both Nevada and Arizona. Also have experience with Group Home placements, Adoptions, CPS, APS and L2K's. Have extensive experience with local and out of state Acute to Acute transfers. Believe in being a team player, but can also work very well independently.
Education and Training
Bachelor of Arts, Applied Behavioral ScienceAshford University － Clinton, IA, United StatesApplied Behavioral Science Coursework for Social Worker, 5 classes left to finish. Certifications for IHS Patient Registration, AHCCCS & PMMIS, Medical Terminology, and IHS Privacy Act Training.
Proven patience and self-discipline
Personal and professional integrity
Relationship and team building
Sound decision making
Cultural awareness and sensitivity
Critical thinking proficiency
Problem resolution ability
Extensive medical terminology knowledge
Problem-solving, great organizational skills, people person. Extensive knowledge and experience with commercial insurance contracts, Medicaid plans for both Nevada / Arizona, Medicare, VA, and Workers Compensation. Know the requirements for LTAC, SNF, Acute Rehab, ALF, group home and inpatient Psych LOC placement. Have experience with Adoptions, CPS, APS and L2K's. Have knowledge and worked with programs like; Cerner, Midas, Curaspan, Meditech.
Discharge Planning CoordinatorSep 2007 to Current Summerlin Hospital － Las Vegas, NV
Represented Case Management / Social Services during the weekend for all discharge planning needs for the entire hospital for 7 1/2 years.
Initiate, coordinate discharge planning including the patient interview, gathering pertinent clinical information, initiating referrals, i.e.
LTAC, SNF, Acute Rehab, Inpatient Psych, ALF, Group Homes, PCA, home health, DME, hospice, infusion therapy, as well as transportation.
Obtain consent and signatures for both patient choice and IM Medicare Letter.
Experience with Adoptions, CPS, APS, and L2K's.
Routinely coordinated and arranged Acute to Acute Transfers for higher level of care for both local as well as out of state.
Provide training for new RN Case Managers and Discharge Planning Coordinators.
Complete daily transitional rounds with unit charge RN and bedside RN's.
Also work with high cost cases and negotiate LOA's when needed for CFO and assist with audits on a monthly basis.
Admission CoordinatorApr 2004 to Jan 2006 Kindred Hospital － Las Vegas, NV
Coordinate and plan the daily operation for all pre-admisison activities.
Coordinate admission with other departments by collecting and distributing the appropriate information.
Assist in completing the Pre-admission Clinical Evaluation (PACE) form to assist in evaluating appropriateness of admission.
Facilitates and coordinates physician-to-physician communication as necessary.
Identifies specific patient needs for equipment, supplies, and consult services.
Provided input into the development of institution policies, objectives, and strategies, as appropriate.
Travel CoordinatorJan 2003 to Apr 2004 Apria Healthcare － Las Vegas, NV
Coordinate the delivery of home oxygen and other DME items to patient's on travel status.
Responsible for all coordinating all oxygen needs for airport, cruises, and train transportation.
Process all route clearing and establish process for billing.
Responsible for all hospital discharge referrals, and coordinating services with hospital Case Managers.
Case ManagerMar 2001 to Oct 2002 OrthoLogic － Phoenix, AZ
Responsible for sales and obtaining authorization from all health insurance benefits for Bone Growth Stimulators (DME).
Assigned to the east coast territory, which covered six states.
Worked with OrthoLogic & DePuy Acromed Sales Representatives.
Worked with all contracted / non-contracted insurance companies.
Negotiated rates with non-contracted providers, and established contracts with prominent insurance companies in my area.
Patient Intake CoordinatorMay 2000 to Feb 2001 Southwest Cancer Clinic － Las Vegas, NV
Responsible for establishing new patients for 7 physicians.
Responsible for obtaining insurance authorizations, scheduling Oncology consultation or Chemotherapy treatment and Bone Marrow Procedures.
Established policies and procedures for the National Bone Marrow Donor program within the practice.
Provided monthly intake reports for 12 physicians within the practice.
Managed Care Referral SpecialistAug 1995 to May 2000 Gila River Healthcare Corp － Sacaton, AZ
Supervisor of 6 staff members.
Coordinated referrals for 27 physicians within the hospital for both inpatient / outpatient services.
Obtained insurance authorizations as needed for all services.
Position involved benefits coordinator, patient advocate, and case management for HIV/AIDS, organ transplants, dialysis, medical transportation.
Responsible for all high cost cases and monitor all dialysis patients.
Member of Contract Health Utilization Review Committee, which authorizes payment process with federal funding.
Work with government, community agencies.
Medical Biller Jul 1994 to Aug 1995 Trinity Hospital － Wolf Point, MTResponsible for data processing all super bills for hospital (inpatient / ER / observation / nursing home and outpatient clinic. Responsible for all ICD-9 coding for all billing purposes and update the pharmacy price listing into the computer program. Responsible for printing reports for management on a daily and monthly basis. Printed UB-82s and HCFA-1500 monthly. Responsible for all purchase orders for IHS patients for hospital; nursing home and clinic for billing / reimbursement.
Medical Biller / Administration AssistantMar 1992 to Jul 1994 Indian Health Services － Phoenix, AZResponsible for medical billing for all IHS hospitals & clinics in Arizona, Nevada and Utah. Handled the billing for all private insurances, reviewed daily the reimbursement checks against the EOB to ensure accuracy of payment. Monitored the daily exporting of private insurance transmittal reports. Organized the unprocessed check report and private insurance collections reports on a weekly basis, which was presented to the IHS Area Director of Finance / Third Party Billing.