Cattina McIntosh

Working PACR/Pend report, Cenpas, Omni, Auth Error, Nicu, building IP and OP medical authorization, claims, Trucare, Amisys, Filenet, Provider data, Members Accounts/ checking eligibility with enrollment, Intake team conformance to guidelines and quality, analyzed and viewed data altered any authorization resolving any mistakes. Provide support to medical staff as needed outreach to providers regarding members care as well as education on submissions.

Intake team for Inpatient Behavioral Health processing Inpatient authorization reviewing and explaining any Outpatient authorization setting up peer to peer for providers to discuss any denied service Checking members eligibility consulting with other nursing staff and assigning cases for review.

Completed administrative patient intakes with case history, insurance information and mandated forms Registered and verified patient records before triage with most up-to-date information. Answered telephone calls to offer office information, answer questions, and direct calls to staff. Obtained prior authorization for Outpatient/Inpatient procedures. Verified insurance benefits and eligibility for Outpatient and Inpatient procedures before submitting prior authorization for service coordinated with in network provider and patients to find cost-effective options for services. I worked with medical inpatient and outpatient, behavioral health inpatient and outpatient, custodial care, NICU, pharmacy, denials, LTSS, special projects claims, grievance & appeals, transportation, lapsed and backlog report.

Reduced process inconsistencies promptly responded to inquires and request for providers updated accounts and maintained detailed records investigated and resolved provider PFIN number assigned by BCBS NPI, Tax ID making them into one record, outreach to provider to ensure we had the most accurate information on file for them.

Completed administrative patient intakes with case histories, insurance information and mandated forms. Collaborated with healthcare staff to verify alignment of appointment scheduling with clinic protocols. Managed multiple schedules and prioritized tasks to meet demands of fast-paced work environment. Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments. Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.