BRITTANIA COLEY
Loganville,GA
Summary
Motivated Care Coordinator with a proven track record of implementing new and innovative programs to meet consumer needs. Skilled in performing duties and assisting with activities related to utilization and coordinated care. Organized professional with extensive knowledge of regulatory standards and compliance requirements. Confident Prior Authorization Specialist experienced in working in medical offices, effectively communicating orally and through writing, and developing prior authorization workflows.
Overview
11
11
years of professional experience
Work History
CARE COORDINATOR III
Centene Corporation
11.2021 - Current
- Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions, or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate.
- Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed
- Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plans
- Develops in-depth knowledge of care management services including responding to some complex or escalated issues
- Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care
- Performs service assessments/screening for members with some complex needs and documents the member’s care needs.
- Documents and maintains member records in accordance with state and regulatory requirements and distribution to providers as needed
- Works with care management team with triaging, adjusting, and escalating complex requests to management
- Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards
- Ability to identify needs and make referrals to Care Manager, community cased organizations, and Disease Manager
- Provide education on benefits and resources available
- May assist with training and development needs
- Performs other duties as assigned
- Complies with all policies and standards
PROGRAM COORDINATOR I
Centene Corporation
01.2018 - 11.2021
- Perform necessary tasks to promote member compliance such as verifying and scheduling appointments
- Assisted with identifying issues in program operations, procedures and policies
- Successfully increased participation in the Start Smart program by encouraging member participation with mass enrollments
- Processing a minimum of 40-50 referrals daily
- Participates in on-going professional development activities: such as meetings, conferences, and training
- Coordinate services with community based organizations
- Attend marketing and outreach meetings as directed to represent the plan
- Produces and mails routine CM letters and program educational material
- Screen for eligibility and benefits
- Identify members without a PCP and refer to Member Services
- Screen members by priority for case management (CM) assessment
- Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs
PROGRAM COORDINATOR I
Healthcare Support Staffing
07.2017 - 01.2018
- Perform necessary tasks to promote member compliance such as verifying and scheduling appointments
- Assisted with identifying issues in program operations, procedures and policies
- Successfully increased participation in the Start Smart program by encouraging member participation with mass enrollments
- Processing a minimum of 30-40 referrals daily
- Participates in on-going professional development activities: such as meetings, conferences, and training
- Coordinate services with community based organizations
- Attend marketing and outreach meetings as directed to represent the plan
- Produces and mails routine CM letters and program educational material
- Screen for eligibility and benefits
- Identify members without a PCP and refer to Member Services
- Screen members by priority for case management (CM) assessment
- Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs
PATIENT CARE REPRESENTATIVE
Go Now Doctors
08.2015 - 11.2016
- Performed insurance verification for Medicare and Medicaid members
- Obtained referrals and authorizations for outpatient diagnostic examinations
- Scheduled patient appointments, investigated past due invoices, and minimized the number of unpaid accounts
- Answered patient's queries related to billing, policies, procedures, and service available
- Filed and documented information and distributed paperwork among the patients
- Scheduled approximately 30-40 patients per week and made reminder calls.
MEDICAL CODING SPECIALIST
Medical Administrative Consultation
05.2014 - 06.2015
- Reviewed physician notes and obtained necessary clarifications where necessary
- Coded records by following prescribed coding standards such as ICD-9 and CPT
- Ensured signatures on all medical records
- Assigned appropriate medical codes to all diagnosis and services
- Utilized classification software to assign clinical codes for reimbursement and data analysis
Education
Certificate of Completion - AAPC Certified Professional Coding
ICode Academy
Atlanta, GA11-2023
High School Diploma - undefined
American Senior High School
Miami Lakes, FL01.2000
Skills
- Customer service experience
- Report Generation
- Team Leadership
- Process improvements
- Proactive mindset
- Medical coding/ Medical billing procedures
- Data entry proficiency
- HIPAA compliance
- Insurance verification
- Healthcare regulations
- Medical terminology knowledge
- Benefit coverage
- Prior authorization processing
- Effective communication skills
- Microsoft office
- Recordkeeping and data input
- ICD-10 coding/CPT coding
- Claim research
- Authorizations
- Outpatient surgery coding
Timeline
CARE COORDINATOR III
Centene Corporation
11.2021 - Current
PROGRAM COORDINATOR I
Centene Corporation
01.2018 - 11.2021
PROGRAM COORDINATOR I
Healthcare Support Staffing
07.2017 - 01.2018
PATIENT CARE REPRESENTATIVE
Go Now Doctors
08.2015 - 11.2016
MEDICAL CODING SPECIALIST
Medical Administrative Consultation
05.2014 - 06.2015
High School Diploma - undefined
American Senior High School
Certificate of Completion - AAPC Certified Professional Coding
ICode Academy
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