Carita Mathews
Atlanta,Georgia
Summary
Knowledgeable and talented Healthcare professional with more than twenty years of managed care and physician's office experience. Seeking an opportunity to utilize and advance my clinical, administrative support and leadership skills. Methodical Program Coordinator offers internal document creation, program management and project implementation expertise paired with outstanding time management and multitasking abilities. Resourceful and versatile professional with over five years of experience developing and coordinating programs.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Program Coordinator Case Management Population Health Clinical Outcome
Centene Cooperation-Peach State Health-Plan
12.2018 - Current
- Verify members' eligibility and benefits
- Manage daily inpatient and discharge census
- Identify members that qualify for case management
- Make daily outreach to members screen and assess members for case management
- Complete post hospital assessments
- Coordinate services for members with healthcare providers based on an integrated model
- Develop member care plans with specific goals, objectives and interventions
- Facilitate and monitors member referrals to community-based organizations
- Perform transition of care duties
- Coordinate services with community-based organizations
- Assist members with locating in-network providers and scheduling care
- Maintain integrity of PHI
- Train new team members on system usage, policies, and procedures
- Assist in the development of standard operating procedures (SOPs) and workflow for my team
- Audit charts to improve quality of care and accuracy to achieve optimal health outcome for members
- Maintaining working relationships with other teams and assistance when needed
- Created and built new templates for daily reporting
- Attend company sponsored community events.
- Served as a liaison between external organizations and partners involved in delivering programming services.
- Developed and implemented program activities according to established goals and objectives.
- Provided guidance and support to program participants in navigating resources, services, and opportunities.
- Managed the day-to-day operations of the program, ensuring compliance with applicable policies and regulations.
- Ensured timely completion of project deliverables within budget constraints.
- Prepared reports on progress towards program goals for management review.
- Participated in the development of new programs or modifications to existing programs.
- Conducted research into best practices for program delivery, including methods for increasing efficiency and effectiveness.
- Evaluated performance data against established objectives to measure success of programs.
- Assisted in developing training materials and providing instruction on how to use them effectively.
- Facilitated communication between team members by organizing regular meetings and conference calls.
- Analyzed data collected from surveys, focus groups, interviews, regarding the effectiveness of the program.
- Identified areas where improvements can be made in order to increase efficiency or effectiveness.
- Recommended process improvements based on data analysis results.
- Explained program offerings and requirements to participants and answered related questions.
- Reviewed applications and documentation independently or in conjunction with supervisor to make decisions pertaining to programs.
Referral and Registration/Patient Access Specialist
Piedmont Internal Medicine
Atlanta, Georgia
08.2015 - 11.2018
- Coordinates all aspects of registration and scheduling
- Obtain payer authorization for advanced imaging procedures and HMO referrals
- Edit claims for any registration errors and payment posting in EMR
- Research and resolved claim inquiries
- Trained new staff on systems, policies, and procedures.
- Maintained accurate records of patient registration information in electronic health record system.
- Assisted with scheduling appointments, pre-registration activities, verifying demographics and insurance information.
- Ensured all required forms were completed accurately prior to patient visit.
- Collaborated with clinical staff to ensure timely processing of orders for tests, treatments and procedures.
- Performed data entry tasks associated with registrations such as entering demographic data into system database.
- Provided support to medical staff by obtaining authorizations from insurers for services rendered.
- Resolved issues related to registration process including eligibility verification and authorization problems.
- Reviewed documentation for completeness and accuracy prior to submitting claims to payers.
- Identified discrepancies between billed charges versus what was actually received from the payer and insurance company.
- Demonstrated knowledge of coding systems used in healthcare setting for reimbursement purposes.
- Processed incoming referrals from outside agencies according to established guidelines and policies.
- Educated patients about financial policies and procedures at facility; explained benefits of various payment options available.
- Served as a liaison between patients and third party payers ensuring that all necessary documents are submitted in a timely manner.
- Worked closely with departmental staff members in order to ensure proper coordination of care across multiple departments.
- Participated in ongoing training sessions related to new technologies or software updates impacting the registration process.
- Analyzed reports generated by EHR system in order to identify areas of improvement within the workflow processes.
- Applied HIPAA privacy and security regulations while handling patient information.
- Responded to patient concerns and inquiries professionally and efficiently.
- Verified demographics and insurance information to register patients in computer system.
Clinical Medical Assistant
Piedmont Healthcare
Atlanta, Georgia
03.2001 - 08.2015
- Front and back-office duties
- Performed EKG testing, bone density, X-rays, injections and phlebotomy
- Managed a high-Volume triage line
- Coordinated and scheduled patient care between specialists
- Precertification of High-cost drugs and diagnostic imaging.
- Performed vital signs, such as blood pressure and temperature, on patients.
- Administered injections and immunizations per protocol.
- Assisted physicians with patient exams and treatments.
- Collected specimens for laboratory testing.
- Prepared exam rooms for patient visits by stocking supplies and ensuring cleanliness.
- Educated patients about medical procedures, medications, diets and other health-related topics.
- Recorded patient medical histories and documented vital signs in electronic medical records system.
- Ordered diagnostic tests, scheduled appointments and maintained patient charts according to established protocols.
- Maintained inventory of medical supplies and ordered replacements when necessary.
- Answered telephones and responded to inquiries from patients regarding their healthcare needs.
- Greeted patients upon arrival at office or clinic; verified insurance information prior to visit.
- Ensured all paperwork was completed accurately prior to submitting it for processing.
- Consulted with doctors concerning changes in patient conditions or treatments plans.
Education
AA Business and BS Human Services -
Shorter University
12.2012
Skills
- Accurately enters data in EMR for registration, billing, patient tracking and charge capture
- Insurance verification, pre-certification and referral coordination
- Claim editing and payment posting
- Perform Point of Service ancillary testing
- Meet or exceed performance goals
- Training and leadership
- Collect financial data during intake
- Advanced knowledge of medical terminology
- Advanced EMR training in EPIC, Centricity and NextGen
- Excellent verbal/written communication skills
- Proficient use of Microsoft Windows, Word, PowerPoint and Excel
- Maintain the integrity of PHI
- Google Workspace (Google Drive, Google Docs, Google Sheets, etc)
- Referral Coordination
- Report Generation
- Financial Administration
- Data Management Familiarity
- Team Oversight
- Process Improvements
- Staff Development
- Project Coordination
- Standard Operating Procedures
- Needs Analysis
- Office Administration
- Program Management
- Staff Evaluation
- Training Coordination
- Resource Management
- Scheduling Proficiency
- Report Preparation
- Persuasive Communication Style
- Program Optimization
Certification
- Certified Health Access Associate - CHAA
- Registered Medical Assistant - RMA
- CPR and First Aide Certified
Accomplishments
- Revenue Cycle: Managed and developed registration and chart auditing processes. Decreased registration errors, minimizing claim denials. Resulting in an 85 percent increase in clean billing.
- Insurance authorizations and Referrals: Collaborating with medical providers and insurance companies to navigate complex referral and insurance requirements to ensure timely authorizations. Consistency achieving high referral approval rates.
Timeline
Program Coordinator Case Management Population Health Clinical Outcome
Centene Cooperation-Peach State Health-Plan
12.2018 - Current
Referral and Registration/Patient Access Specialist
Piedmont Internal Medicine
08.2015 - 11.2018
Clinical Medical Assistant
Piedmont Healthcare
03.2001 - 08.2015
AA Business and BS Human Services -
Shorter University
- Certified Health Access Associate - CHAA
- Registered Medical Assistant - RMA
- CPR and First Aide Certified
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