Nataija Farrington

Support Comprehensive of medical services, including Care Team intake, screening & supporting the implementation of care plans to promote effective utilization of healthcare services

Responsible for initial review & triage of Care Team tasks

Identify principle reason for admission, facility, and member product to correctly apply intervention assessment tools.

Screens patients using targeted intervention business rules and process to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan

Monitor non-targeted cases for entry of appropriate discharge date and disposition

Identifies and refers outlier cases (e.g., length of stay to clinical staff) identifies triggers for referral into Aetna’s Case Management, Disease Management, Mixed Services, & other specialty programs

Utilize Aetna systems to build, research and enter member information, as needed

Support the Development and Implementation of Care plans

Coordinates and arranges for health care service delivery under the direction of nurse or medical direction in the appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating provider and services

Promote communication both internally and externally to enhance effectives off medical management services (e.g., health care provider, and health team members respectively

Perform non-medical research pertinent to the establishment, maintenance and closure of open cases

Provide support services to team member by answering telephone calls, taking messages, researching information and assisting in problem solving

Maintain accurate and complete documentation of required information that meets risk management, regulatory and accreditation requirements

Protect the confidentiality of member information and adheres to company policies regards confidentiality

Assist in research and resolution of claims payment issues

Input ICD-9/ICD-10 codes while loading referrals

• Navigated within patient records to locate requested documentation, successfully completing over 60 requests per day.
• Coordinated patient information flow through caregivers, insurance companies, billing departments and patients.
• Reproduced protected health information by using data extraction and file management techniques.
• Completed certifications and notarization of documents for court and legal purposes.
• Date stamped requests and highlighted pertinent data to facilitate processing.
• Resolved medical record discrepancies by collecting and analyzing information.
• Handled phone calls from attorneys, insurance companies and patients.
• Maintained accuracy, completeness and security for medical records and health information.
• Input data into computer programs and filing systems.
• Reviewed medical records for completeness and filed records in alphabetic and numeric order.
• Communicated effectively with staff, patients and insurance companies by email and telephone.
• Maintained database for storage and retrieval of medical records.
• Compiled electronic patient records covering conditions, treatments and diagnoses.
• Processed patient admission and discharge documentation.
• Generated cover letters, pre-payment notices and invoices to mail information to requestors.