ANGELA ELLIOTT
Casa Grande,AZ
Summary
Experienced Clinical Administrative Coordinator well-versed in handling benefits administration, patient admissions, care coordination, case management and medical determination letter writing in busy healthcare environments. Highly organized and detail-oriented with excellent planning and communication skills. Successful at managing multiple priorities while maintaining a strong work ethic and exhibiting a positive attitude. Prepared to offer over 10 years of related experience to a challenging new role with room for advancement.
Overview
28
28
years of professional experience
Work History
Clinical Administrative Coordinator
UnitedHealthcare Enterprise Clinical Services
2019.11 - Current
- Draft and communicate medical service decisions via letters to members and providers within NY and NC Medicaid and Medicare lines of business.
- Ensure letter documentation meets client, regulatory and accreditation requirements.
- Detailed understanding of State and Federal regulations concerning benefits and services.
- Demonstrates understanding of each specific plan by selecting correct letter template.
- Maintains 100% quality scores for several months consecutively.
Clinical Administrative Coordinator
Harken Health Plan
2016.07 - 2019.11
- Manage inpatient notifications, monitor member’s inpatient status , while obtaining discharge dates from facility medical records department
- Request clinical information from hospital Utilization Review Departments, and prepare case for concurrent review
- Upload and create documents within organization’s electronic records system
- Ensure accuracy of information entered on system to allow Preservice RN or Medical Director to make appropriate decision according to plan guidelines
- Process daily reports , to include Inpatient Census, Outpatient Census, and PGBA (Inform)
Senior Clinical Administrative Coordinator
UnitedHealthcare Military & Veterans
2014.01 - 2016.07
- Nominate beneficiaries for case management services based on diagnosis , self-referral or Military Treatment Facility referral and advocate to ensure members needs are met
- Built strong relationships with patients and families for optimized care satisfaction.
- Provide telephonic assistance to plan members experiencing Behavioral Health concerns and crisis
- Outreach to referred providers on behalf of members to minimize possible gap in care
- Mentored new non-clinical staff members for proper onboarding and orientation processes.
- Maintained complete documentation for permanent records and auditing purposes.
- Nominated by my peers and received Above and Beyond the Call of Duty award, (NAC) national security clearance successfully obtained
Clinical Administrative Coordinator
UnitedHealthcare Employer & Individual Services
2012.11 - 2014.01
- Reviewed and processed prior authorization requests , to include verification of ICD -9 / ICD -10 coding and CPT codes
- Completed medical service requests, generated approval or denial letters as appropriate
- Exceeded Internal quality and production standards over last several months
- Provided comprehensive administrative support to department staff.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
Member Services Representative
Humana Pharmacy
2011.10 - 2012.11
- Provided prescription medication benefits information according to members chosen plan
- Processed inbound calls from members ordering prescriptions and over the counter medications
- Verified and tracked shipments of medications to members residence utilizing medication management systems
- Researched and resolved customer billing issues according to company guidelines
- Call audit and member satisfaction survey average 100 percent over 12 months
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Responded to customer calls and emails to answer questions about products and services.
- Handled complaints with prompt, courteous service to uphold professional reputation.
- Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions.
- Learned internal systems and related service role duties to provide skilled team backup in handling customer demands.
- Resolved customer issues through thorough dispute investigation.
Patient Intake-Care Coordinator
Fresenius Medical Care
2010.10 - 2011.07
- Received and processed patient information such as demographics and insurance information into Lotus Notes and E-Cube Financial and Clinical systems
- Worked closely with Nephrologists, Social Workers, and other clinical staff to obtain required medical records and insurance information for admission to the outpatient dialysis unit
- Utilized Meditech, version 5.2 and Meditech Unity to obtain electronic hospital records
- Assisted Billing Group personnel with trouble-shooting problematic insurance verifications
- Responsible for communication of patient placement into dialysis unit and treatment time to referral source or patient
- Received recognition of outstanding service to program from Nephrology group located in Corpus Christi
- Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Built strong relationships with clients to deliver emotional support and companionship.
Communications Specialist
United States Army
1995.06 - 1999.03
- Assisted in installation, operation and maintenance of Remote Access Units and Multichannel Transmission Systems capable of processing large amounts of data
- Provided quality communications for numerous supported units
- Handled troubleshooting and provided vital solutions to problems within network
- Upgraded, serviced and maintained equipment to highest level of technology
- Army Achievement Medal received – Ft Hood, TX -For meritorious service as Remote Access Unit Operator during deployment to National Training Center, Fort Irwin CA
Education
Bachelor of Arts - Business Administration - Healthcare Management
Western Governors University
Salt Lake City, UT10.2024
Associate of Arts -
Community College of Aurora
Aurora, Colorado2006
Skills
- Proficient in Microsoft Office Products
- Utilized and mastered healthcare applications
- Significant knowledge of medical terminology
- Telephone Customer Support
- Medicare/Medicaid
- Documentation Skills
- Clerical Assistance
- Records Reviews
Timeline
Clinical Administrative Coordinator
UnitedHealthcare Enterprise Clinical Services
2019.11 - Current
Clinical Administrative Coordinator
Harken Health Plan
2016.07 - 2019.11
Senior Clinical Administrative Coordinator
UnitedHealthcare Military & Veterans
2014.01 - 2016.07
Clinical Administrative Coordinator
UnitedHealthcare Employer & Individual Services
2012.11 - 2014.01
Member Services Representative
Humana Pharmacy
2011.10 - 2012.11
Patient Intake-Care Coordinator
Fresenius Medical Care
2010.10 - 2011.07
Communications Specialist
United States Army
1995.06 - 1999.03
Bachelor of Arts - Business Administration - Healthcare Management
Western Governors University
Associate of Arts -
Community College of Aurora
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