Amanda Fleming

• Perform comprehensive reviews of medical records and supporting documentation to evaluate medical necessity, accuracy, and completeness of submitted information
• Analyze complex clinical data, treatment history, and provider documentation to support evidence-based decision-making
• Apply Medicare and Medicaid guidelines, including CMS criteria, to ensure compliance with regulatory and coverage requirements
• Develop clear, concise clinical summaries and written determinations to support appeal outcomes and communicate findings effectively
• Identify inconsistencies, gaps, or trends in documentation and recommend appropriate resolutions or next steps
• Utilize CPT, ICD-10, and HCPCS coding knowledge to support accurate review and interpretation of services and treatment plans
• Collaborate with cross-functional teams including quality, compliance, and operations to ensure alignment with organizational and regulatory standards
• Participate in process improvement initiatives by identifying workflow inefficiencies and contributing to solutions that enhance accuracy and turnaround times
• Serve as a point of escalation for complex cases, applying critical thinking and clinical judgment to resolve issues while maintaining compliance standards
• Track and monitor individual and departmental performance metrics, ensuring adherence to productivity and quality expectations
• Maintain detailed, accurate documentation while managing a high-volume workload with strong attention to detail and timeliness
• • Interpret complex medical histories to project future care needs based on clinical findings and treatment patterns

• Supervised care coordination staff across multiple clinic sites, ensuring consistency in workflows, performance expectations, and patient care delivery
• Oversaw chronic care management programs, monitoring productivity, quality metrics, and program effectiveness across clinics
• Reviewed patient records and care plans to identify gaps in treatment, opportunities for improved outcomes, and compliance with clinical guidelines
• Analyzed care coordination trends and performance data to support process improvement initiatives and enhance patient engagement
• Collaborated with physicians, specialists, and multidisciplinary teams to ensure continuity of care and alignment with organizational goals
• Developed clear, concise clinical documentation and summaries to support care planning and communication across care teams
• Implemented workflow improvements that increased efficiency, reduced delays, and supported overall program performance
• Supported onboarding and training of care coordinators, providing guidance, feedback, and ongoing performance support
• Addressed performance concerns through coaching and development plans while maintaining accountability to program standards
• Ensured compliance with regulatory requirements and internal policies related to care coordination and documentation
• Managed competing priorities across multiple clinics while maintaining high standards of organization, accuracy, and timeliness

• Delivered urgent and primary care services, including medication administration, patient triage, and provider support in procedures.
• Assisted with patient flow optimization, ensuring efficiency in a high-volume, fast-paced clinic environment.
• Maintained cleanliness of work area; stocked supplies as needed; disposed of hazardous materials properly.
• Supported wound care needs and related nursing duties.
• Assisted with admissions, discharges of patients; completed necessary paperwork related to admission, discharge process.

• Managed clinical and administrative workflows, including prior authorization processes, surgical scheduling, and allergy program coordination

• Collaborated with providers and staff to streamline scheduling, patient preparation, and follow-up workflows, ensuring high-quality care delivery.
• Educated patients and families on treatment plans, medication adherence, and care expectations, supporting long-term outcomes.
• Administered injections according to established guidelines; documented injection administration accurately.
• Monitored patient conditions throughout shift; reported any changes in condition promptly to medical staff.
• Utilized critical thinking skills to assess complex situations, develop solutions, and implement interventions when needed.

• Provided direct patient care to diverse patient populations.
• Supervised nurses' aides and assistants.
• Answered patient calls and determined proper course of care.

• Collected samples, such as blood, urine, and sputum from patients and performed routine laboratory tests on samples.
• Utilized computer systems for charting patient data.
• Supported nurses and physicians in patient monitoring, specimen collection, and emergency procedures.
• Coordinated communications and patient flow as a ward clerk and ED liaison.
• Reported changes in patient status to nursing staff in a timely manner.

• Greeted patients, managed front-desk operations, and processed copay and deductible payments.
• Scheduled specialist referrals, and return appointments, ensuring coordinated patient care.
• Measured and recorded patient vital signs, obtained medical histories, and assisted providers with examinations and procedures.
• Prepared and maintained patient medical records, coordinating with other providers and insurance companies to support continuity of care.