Alexis Desormier

In an environment of continuous quality improvement, the Denials Management Coordinator is responsible for the review of all denials to determine patterns in errors, payers, and internal processes to improve our denial rate. A Denials Management Coordinator must use clinical knowledge to examine denials and determine the need for an appeal.

• Collaborating with healthcare providers, insurance companies, and other relevant parties to resolve denied claims
• Monitoring and tracking denials to identify trends and patterns that may require process improvements or additional training
• Maintaining accurate records and documentation of denial activities, including appeals and resolutions
• Assisting with the development and implementation of denial prevention strategies and initiatives
• Facilitate meetings with stakeholders to gather requirements and align project objectives with organizational goals.

Reviewed claims and payment data to ensure accurate billing to and payments from all Commercial, Managed Care, and Governmental Payers to ensure compliance with all payer contracts and fee schedules.

• Monitored to ensure payments from contracted payers were timely and within contracted payment terms
• Reviewed reimbursement and variance reports to identify trends and discrepancies
• Prepared detailed underpayment and denial reports and distributed to appropriate teams for resolution
• Utilized approved charge capture auditing systems to identify missed charges
• Provided education and support to Revenue Integrity and Patient Accounts team members as directed

Responsible for application support and implementation within the Information Services Department.

• Analyzed system requirements to optimize operational efficiency across healthcare applications.
• Lead project panning, implementation, support, and follow up
• Implemented change management processes to facilitate smooth transitions during system upgrades or modifications.
• Provided support to Cerner CareAware Patient Flow Applications
• Performed regular audits, identifying any trends, and implementing corrective actions when appropriate
• Improved education for customer service center, nursing staff, and providers on applications
• Performed regular audits, identifying any trends, and implementing corrective actions when appropriate
• Completed the following Cerner courses:
• Cerner Millennium Fundamentals, Cerner Millennium ATIM, Cerner iBus Fundamentals, Cerner Building and Maintaining PowerChart, Cerner Introduction to Event Set Hierarchy, Cerner Millennium Building and Maintaining PowerOrders

Formerly a certified medical assistant in a very fast paced pain management office. My responsibilities included, but were not limited to the following:

• Prepared patients for the visit, collected urine drug screens and vitals
• Verified patient information by thorough patient interviews; reviewed and/or recorded medical history. Completed records by recording patient examination, treatment, and test results
• Supported patient care delivery by assisting providers during examinations; collected/prepared laboratory specimens; sterilized medical instruments; administered medications on the premises; authorized drug refills as directed; telephoned prescriptions to pharmacies; drew blood; changed dressings; and other tasks as directed by the attending provider
• Participated as an active team member in the surgical team; prepare patient for injections/procedures, practice sterile technique, prepared surgical area for procedures, maintain procedure records, and assist provider when necessary
• Increased patient safety by meticulously following infection control protocols and maintaining a sterile environment.

Formerly a certified medical assistant in a very fast paced internal medicine office. My responsibilities included, but were not limited to the following:

• Obtained patient medical history and vital signs
• Assisted physician during patient examinations
• Performed routine laboratory tests and administered injections, nebulizer treatments, CLIA waived tests, and urinalysis testing
• Performed electrocardiograms or other diagnostic tests
• Monitored drug refill requests and provided prescription information to pharmacies
• Assisted with insurance, coding, and billing paperwork
• Assisted office manager with tasks such as auditing, organizing, and managing provider and nurse credentialing for over 40 employees
• Assisted with redesigning the Quality Assurance Program for CLIA and non-CLIA waived tests as well as the prescription sample program
• Aided in designing control plans, communication plans, and risk management plans for the Quality Assurance Programs

Also, performed clinical preceptor roles and responsibilities. Examined new employees practical clinical experience and guided orientation of new clinicians.

• Observed clinical skills and patient interaction of new clinicians and provided feedback to the clinician
• Worked with clinicians to review application of clinical documentation and forms
• Reviewed Orientation Module content with new clinicians to determine the clinicians' level of understanding and re-educated as necessary
• Consulted with the clinical faculty liaison as necessary

This position, in the Patient Access Center is responsible for coordinating aspects of the patient appointment, including authorizations and insurance verification. Responsibilities include:

• Answer telephone in a timely and courteous manner
• Assisted in maintaining accurate medical records and patient information systems.
• Processed insurance claims and verified patient eligibility for services.
• Schedule appointments with physicians and mid-levels
• Inform patients about set appointments and provide them with information concerning physician’s office and any documents they may need to take with them to the appointment
  
  After just a few months in the position and proving my medical knowledge, I was asked to be a Medical Assistant to the Transition of Care Coordinator. These responsibilities include:
• Access the Venice Regional hospital records to obtain the daily inpatient and observation discharges list managing 40-80 discharges daily.
• Maintain a spreadsheet monthly to track patient contact, admission/discharge dates, and physicians.
• Register patient if they are not a current patient.
• Obtain records pertaining to the patients' diagnosis to upload into their chart for the PCP or specialist.
• Make outgoing calls to patients within two business days, discussing their quality of care, and schedule a follow-up within 14 days of discharge.
• If the patient was treated at another facility, then I made contact by phone or fax with them to obtain records.

From May to August, I worked in an internal medicine office performing the following duties and tasks:

• Checked in patients, obtained vitals, and placed the patient in the examination room.
• Reconciled patient prescriptions and monitored the prescription requests for the physician.
• Faxed and called in appropriate prescriptions
• Called to notify patients of controlled substance prescriptions for pick-up.
• Transported patients to the hospital for direct admission per physician request.
  

Filled in for receptionist occasionally. During this time, I preformed majority of my other duties along with:
o Welcomed patients and visitors, in person or on the telephone; answering or referring inquiries.
o Maintained patient accounts by obtaining, recording, and updating personal and financial information.
o Collected medical insurance co-payments.
o Rescheduled patients for future appointments.
o Called patients to remind them of appointments the following day.

From December 2017 to January 2016 I was asked to perform duties as a Chronic Care Management Medical Assistant under supervision of a CCM Registered Nurse:

• Provided non-face to face assessments of patients with 2 or more chronic conditions, and documented all patient calls in the EHR.
• Provided education on the importance of medication compliance, diet, exercise etc.
• Obtained outside records from specialists or admissions.
• Actively communicated with staff and physician on any issues with patients enrolled in the CCM Program.