Ayesha Payne
New York
Summary
Highly skilled and enthusiastic Healthcare Administration professional well-versed in medical records management, providing non clinical support and managing employees to provide exceptional services. Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.
Overview
9
9
years of professional experience
Work History
Medical Records Director
The Riverside Premier Nursing & Rehab
08.2023 - Current
- Abstracted information from records as authorized or requested by insurance companies and other third-party payers.
- Oversaw secure transfer of patient records to other health care providers to support requests and authorizations.
- Lead a team of unit clerks, improving medical records retrieval efficiency, promoting teamwork and consistently meeting departmental goals.
- Prepare death certificates as requested for third parties and family members, review Physicians Dea, to grant access for death certificates creation & update access ongoing basis.
- Conducted regular audits of stored medical records to identify discrepancies or missing documentation, ensuring completion and adherence to established guidelines.
CLINICAL REVIEW COORDINATOR -Remote
Center Light Healthcare
02.2022 - 11.2022
- Verified accuracy of patient information in medical records.
- Supported the Clinical Review/UM department by processing requests for authorization & by assigning appropriate clinical staff for review.
- Processed approval and denial letters to be sent to providers within required timeframes.
- Completed approval & denial authorizations for inpatient acute/Short term & long-term rehab as well as outpatient request.
- Initiated authorization process for inpatient request, entering necessary ICD & CPT 10 codes.
Insurance Verification Specialist
Mount Sinai West Hospital
04.2019 - 02.2022
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Entered certification and denial data into Allscripts based on review of payor End of Day Reports, notification from internal and external Case Managers, financial screening, and other personnel within required time frame.
- Received, generates and processes sub-acute rehab and long-term care requests.
- Assist with denial management, discharge appeals & authorization request, prepares concurrent review information for Review/Appeals.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Trained new staff on current, correct insurance verification procedures.
Patient Access Coordinator/COVID-19 Contact Tracer
Rhode Island Dept of Health
11.2020 - 07.2021
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Patient registration, collect and document patient demographics, medical history, current symptoms, last known contact/exposure, physician, and insurance information into NICE-CRM.
- Understand symptoms, infectious periods, and treatments, provided guidance on isolation, incubation and quarantine based on CDC guidelines.
- Schedule callers for Covid19 test, provide results, and notify contact of their exposure to COVID-19, following script or guidance to provide COVID-19 health education.
- Answered incoming calls, scheduled appointments and filed medical records.
- Engaged with patients to provide critical information.
- Handled large call volume of 100+ calls daily on open que line.
MEDICAL MANAGEMENT COORDINATOR
Affinity Health Plan
03.2016 - 04.2019
- Accountable for handing 50+ call volume per day with over a dozen medical facilities to process timely authorization request submitted to health plan.
- Monitor & initiate authorization requests for various levels of care, such as inpatient admission, concurrent review, denial appeals review, sub-acute rehab, hospice.
- Entered ICD codes for authorizations and billing.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Updated patient records with accurate, current insurance policy information.
Education
Bachelor of Arts -
SUNY At Oswego
OswegoSkills
- Cross-functional collaboration
- Training, Scheduling, Supervising Teams
- Quality Assurance, Workflow Optimization
- Performance improvement mechanisms
- Records administration
- Documentation management
- EHR, HIPAA Compliance, Patient Registration, Medical Terminology (ICD-10, CPT)
- Discharge planning coordination
- Electronic authorization processing
- Customer service
Timeline
Medical Records Director
The Riverside Premier Nursing & Rehab
08.2023 - Current
CLINICAL REVIEW COORDINATOR -Remote
Center Light Healthcare
02.2022 - 11.2022
Patient Access Coordinator/COVID-19 Contact Tracer
Rhode Island Dept of Health
11.2020 - 07.2021
Insurance Verification Specialist
Mount Sinai West Hospital
04.2019 - 02.2022
MEDICAL MANAGEMENT COORDINATOR
Affinity Health Plan
03.2016 - 04.2019
Bachelor of Arts -
SUNY At Oswego
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