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Injury Coordinator Resume Example

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Jessica Claire
, , 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Summary

Hardworking and reliable referral coordinator with 3 years experience in healthcare medical insurance and 1.5 year experience with worker's compensation. Over 10 years experience in the healthcare industry. Performs well in busy, customer focused settings. Considered valuable, reliable individual with experience in utilization management, behavioral health, and worker's compensation.

Skills
  • Documentation
  • Organizational skills
  • Data entry
  • CRM and office management software
  • Excel
  • Authorizations
  • Medical Assistant
  • Utilization review
  • Behavioral health
  • Clinical review
  • Customer service
  • Outbound provider and member calls
Experience
01/2020 to Current
Injury Coordinator Hcsc Abilene, TX,
  • Obtain office visit notes following each office visit within 24 hours of every office visit and verify work status.
  • Reviews analytic reports for opioid use.
  • Assist telephonic case manager by reviewing the notes to see if treatment is required and notify telephonic case manager so telephonic case manager can work with adjuster on facilitating those services.
  • Summarize the office visit notes and notify adjuster to obtain authorization to proceed with scheduling.
  • Support claims adjusters with requests as needed to obtain medical records from providers.
  • Schedule appointments for provider office visits, physical, and occupational therapy.
  • Contact claimants to find out specific information regarding their claim.
  • Monitor ancillary services scheduling including delivery of durable medical equipment, imaging, transportation, translation.
  • Monitor reserve amounts and return to work guidelines.
  • Provide file summary of records and update task lists for follow up actions.
  • Identify any red flags and request review of file by case management such as continued use of narcotics, non-compliance with treatment plan, no progress with PT/OT, surgery, history of work claims, history of pain pills prior to work injury, diagnostic test shows tear herniated disc, fracture, history of treatment for depression, mental illness, anxiety disorder, drug or alcohol problems, change of work status from full duty to light duty or off work.
  • File assessment every 30 days or after each new office visit on indemnity files.
  • Securing documentation in clients server.
  • Utilization review phone calls
06/2018 to 07/2019
Utilization Management Inpatient Coordinator Community Healthlink, Inc. Leominster, MA,
  • Monitoring the right fax server, EDI interface, and medical management system intake to all face sheets are processed in a timely manner.
  • Ensuring that hard copy and electronic face sheets are complete and accurate to reflect current member demographic information.
  • Responsible for daily review of the daily census report in an effort to eliminate duplicates or other admission received not required by the health plan.
  • Responsible for the approval of service requested within the inpatient coordinator scope as indicated by the utilization management guide approved by the utilization management subcommittee.
  • Obtaining member discharge dates through daily calls or memo submissions to contracted and non-contracted facilities.
  • Responsible for meeting the performance measurement standards for productivity and accuracy as well as timely processing of inpatient authorizations, inpatient service requests, and discharges.
  • Ensuring that members receive home health or durable medical equipment items as ordered via phone call or documentation of call within the medical management system.
  • Responsible for representing the Inland Empire Health Plan is a friendly and professional manner while answering the calls for the utilization management department.
  • Communication with providers/facilities in consultation with the utilization management nurse, regarding authorizations, orders, and clinical reviews.
  • Assist and provider support to management or inpatient clinical team as requested.
  • Used troubleshooting methods to identify issues with mechanical tools.
06/2016 to 07/2018
Behavioral Health Coordinator Inland Empire Health Plain City, STATE,
  • To ensure all request for additional services forms, county forms, and coordination of continued forms for continuation of behavioral health services are processed reviewed and triage correctly within 24 hours from the received date of the request.
  • Process inpatient and outpatient authorizations from hospitals and healthcare facilities within 24 hours.
  • Run daily in progress reports and end of day reports to supervisors and management.
  • Use excel on a daily basis by creating pivot tables and spreadsheets for daily team huddles.
  • Check member eligibility before processing authorization requests.
  • Generate in progress authorizations and submit to nurse/clinical review.
  • Call out to providers and healthcare facilities for clinical information.
  • Monitor the request web forms and faxes and ensure they are being received on the scheduled times.
  • Check preliminary review of the request before submitting for nurse/coordinator review.
  • Take provider calls and assist providers with any behavioral health questions and requests.
  • Assisting intake team in processing other web requests or faxes in intake queue.
11/2006 to 07/2012
Medical Assistant Beaver Medical Group City, STATE,
  • Lead assistant of patient care for physician practices.
  • Checkup on patient history and measure vital signs.
  • Assisted physician with patient examinations and surgeries.
  • Provide patient injections as directed by physician.
  • Prepare laboratory specimens, dispose of contaminated supplies, sterilize instruments.
  • Take electrocardiograms, remove sutures, and change dressings.
  • Scheduled patient appointments and input authorizations.
  • Refill and call in medications.
  • Utilized phone systems in answering inbound calls and making outbound calls.
  • Provide follow-up services on messages left for the physician.
Education and Training
Expected in
: Healthcare Administration
DePaul University - Chicago, IL
GPA:
Expected in
Associate of Science:
Crafton Hills College - Yucaipa, CA
GPA:
Expected in
: Medical Assistant
Bryman College - San Bernardino, CA,
GPA:
Expected in 06/2005
High School Diploma:
Beaumont High School - Beaumont, CA,
GPA:

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Resume Strength

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Resume Overview

School Attended
  • DePaul University
  • Crafton Hills College
  • Bryman College
  • Beaumont High School
Job Titles Held:
  • Injury Coordinator
  • Utilization Management Inpatient Coordinator
  • Behavioral Health Coordinator
  • Medical Assistant
Degrees
  • Some College (No Degree)
  • Associate of Science
  • High School Diploma

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