Carlyne Dorlass
Pompano Beach
Summary
Professional Administrative Coordinator with strong administration skills, exceptional communication and interpersonal skills. Ability to supervise, delegate, as well as multi-task. Skilled in organization and time management, maintain and protect confidential files, as well as develop innovative systems for maximizing efficiency. Experienced in Coding, Insurance verification, and billing.
Overview
14
14
years of professional experience
Work History
Utilization Review Coordinator
Holly Cross Hospital
Fort Lauderdale
08.2023 - Current
- Reviewed patient care plans for medical necessity and compliance standards.
- Coordinated with healthcare providers to ensure accurate utilization reviews.
- Maintained comprehensive documentation of utilization review processes.
- Trained staff on utilization review policies and best practices.
- Investigated denials from payers for lack of medical necessity or level of care issues.
- Maintained accurate data entry into a computerized system related to UR activities.
- Provided feedback to healthcare providers on clinical documentation improvement to support utilization review.
- Performed pre-certification, concurrent, and retrospective reviews of inpatient and outpatient services.
- Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
Patient Service Rep
Stamford Hospital
Stamford
02.2018 - 08.2023
- Maintained department standards of productivity.
- Provided timely and accurate information regarding patient date, case status, to other health system departments, physicians, office staff and other publics while ensuring patient confidentiality is not breached.
- Performed other related duties as assigned or requested to maintain a high level of service.
- Complied with departmental organizational policies and procedures and adhere to external agency requirements.
- Worked closely with all lines of business to ensure appropriate billing.
- Provided timely and accurate information regarding case status.
- Updated cases accordingly with payer’s determinations.
- Worked closely with the CM to avoid delay in billing.
- Updated patient’s account accordingly.
- Verified benefits.
- Ensured prompt, accurate and compliant billing for all third-party patient claims.
- Resolved failed billing edits and claim submission rejections.
- Verified member’s insurance benefits.
- Kept current with the changes to billing regulations and protocols. Have a clear understanding of how these changes will impact the hospital’s department.
- Demonstrated professional work behavior by following service standard and success factors.
- Analyzed past due accounts to submit to a third-party collection agency.
- Initiated requests for refund to patients due to overpayment.
- Responded professionally to all billing related discrepancies and questions.
- Processed requests by insurance companies and attorneys regarding patients' accounts.
- Reviewed patient accounts ensuring insurance and demographic information is correct.
- Performed confidential financial screening to determine a patient's eligibility for hospital financial.
Authorization Specialist
Vanguard Medical Group
04.2014 - 02.2018
- Reviewed and processed pre-authorizations in a timely manner.
- Analyzed referrals and submitted medical records to insurance companies for consideration of medical necessity.
- Updated patient’s account.
- Verified benefits.
- Managed patients’ confidential files.
- Heavy phone and email correspondence.
- Performed other related duties as assigned.
Referral Coordinator
Westport Family Health
06.2011 - 03.2017
- Greeted patients in a professional manner at time of check in procedure.
- Collected patients’ co-pays as well as owed balance on accounts.
- Scheduled patients for follow up appointments.
- Ensured patients' files remained current and accurate.
Education
Certified Medical Assistant -
Keiser College
Palm Beach Garden, FL01.2001
Medical Billing -
QiTraining Direct
Bridgeport, CTSkills
- Utilization review
- Medical necessity
- Clinical documentation
- Data entry
- Compliance standards
- Healthcare coordination
References
Upon request
Education And Licensure
- QiTraining Direct, Bridgeport, CT, Medical Billing
- Keiser College, Palm Beach Garden, FL, Certified Medical Assistant, 2001
Timeline
Utilization Review Coordinator
Holly Cross Hospital
08.2023 - Current
Patient Service Rep
Stamford Hospital
02.2018 - 08.2023
Authorization Specialist
Vanguard Medical Group
04.2014 - 02.2018
Referral Coordinator
Westport Family Health
06.2011 - 03.2017
Certified Medical Assistant -
Keiser College
Medical Billing -
QiTraining Direct
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