A self-starter requiring minimal supervision with effective communicator, both written and verbal. Resourceful in problem solving and maximizing available resources. Highly organized with ability to track and handle multiple tasks/deadlines.
Overview
53
53
years of professional experience
Work History
Supervisor , Healthcare Services Operationap Support
Molina Healthcare
Syracuse, NY
10.2021 - Current
Operational Efficiency: Assists in implementing health management activities in accordance with regulatory, contract standards and accreditation compliance
Functions as “hands-on” supervisor, assisting with assessing and evaluation of systems, day to day operations and adherence to health management program to maintain and/or improve quality and efficiency of health management program operations/services
Training: Assists in coordination of orienting and training staff, new and existing, to ensure maximum efficiency and productivity, program implementation, and service excellence
Oversight: Assists with staff Performance Appraisals, ongoing monitoring of performance, and application of protocols and guidelines
Collaborates with and keepsManager, Healthcare Services apprised of operational issues, staffing, resources, system and program needs
Assists with coordination and reporting of department statistics and ongoing client reports, as assigned
Performance, change and new system testing for programs used by organization for corporate standards
Auditing of staff to ensure adherence to corporate and health plan processing standards.
Created successful work schedules for each team member to maintain deadlines and fully staff shifts.
Program Coordinator
Molina Healthcare
Syracuse, NY
06.2020 - 10.2021
Daily generate Que Reports (UM and BH), Productivity statistics for CRC, CRP and CPs
Monitor Out of TAT authorizations and report to management
BiWeekly review of authorizations for missing data in preparation for NYS Article 44 audit
Work with MHI NY Compliance Officer to ensure compliance to regulations
Review and update Claims Pended for UM, work with various departments to resolve claims
Train, monitor and audit Correspondence Processors, conduct secondary sign off as required for specific letters or LOB; conduct monthly audits
Serve as ME for correspondence processing, assist CRCs in completing denial letters
Train, monitor and audit Care Review Processors, conduct monthly audits, assist in pulling Hospital Roster clinical and Single Case Agreements
Monthly Key Performance Indicators (KPI) report
Provided ongoing direction and leadership for program operations.
Designed program implementation and maintenance plan.
Addressed and resolved technical and operational concerns by working with team members and directors.
Care Review Processor
Molina Healthcare
Syracuse, NY
11.2018 - 06.2020
Letter audit of approval letters for Utilization Management (UM) along with extension and denial for Behavioral Health (BH)
Submit letters for translation from UM, BH and Corporate
Track for completion, when returned upload to A&G and mail to member
Complete morning and evening reports of Que boxes for UM and BH
Special projects such as processing requests that would have been sent to Evicore
Clerk, create shells, administration approve and write letters
Trained staff (CRP, CRC and management) on pulling information from Crouse Hospital Soarian and Kaleida Hospitals EPIC systems for inpatient admissions
Pull and forward Hospital Rosters to staff daily
Assisted with the preparations of the State Audit, which consisted of verifying attributes in UMK2 and letters available in A&G
Cover phone queue as necessary
Cover CRP letter writing during absences
Notify team of CHP authorizations and approve letters
Second review of Reconsideration Denial letters
Special Project – assisted Appeals Manager with input of cases into Appeal Log indicating assigned reviewer
Participated in interdepartmental integration and collaboration to enhance continuity of care for client members.
Worked within care access and monitoring team to offer clerical and data entry support for members requiring hospitalization and utilization review for healthcare services.
Clinical Information Coordinator
Crouse Health Hospital
Syracuse, NY
03.2004 - 11.2018
Provide insurance companies with initial and concurrent clinical reviews for patient’s in house and discharged
Work with Denial Coordination Specialist and Business Office Medical Claims Administrator to ensure clinical has been forwarded to necessary payers and assist in obtaining approval authorizations
Work with insurance payers to ensure access to necessary patient information, either through remote access to EMR or efaxing paperwork
Track status of all patient stays after paperwork has been forwarded, to include next review day and authorization status
Update Financials with authorizations and next review date information
Perform Denial Coordination Specialist duties in her absence to include setting up
Peer-to-Peer reviews for possible denials.
Achieved specific team objectives and collection activity.
Faculty Secretary
Crouse College Of Nursing
Syracuse, United States
03.2004 - 11.2018
Assisted coworkers and staff members with special tasks on daily basis.
General secretarial duties for entire faculty – included test preparation, meeting minutes, attendance reports
Compiled and organized document for annual Clinical meeting for all nursing colleges in the area
Compiled student paperwork required for clinical at other facilities such as Upstate, Veterans Hospital and others
Set up necessary training at facilities
Maintained tracking system to ensure all students were current with CPR, health insurance
Set up students in Netlearning for required CBLs for Crouse Hospital
Secretary – Madison Irving Surgery Center
Check in patients for one-day surgery, compile chart and obtain necessary signatures
Process billing for surgery cases
Typed all general correspondence and minute minutes
Covered for secretary at POB surgery center when needed
Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
Administrative Secretary
Crouse Health Hospital
Syracuse, NY
03.2004 - 11.2018
Hospitalist Office
Scheduled patient follow up appointments for discharging patient
Obtained from PCP relevant health records for patients admitted to Hospitalist service
Assist in obtaining PCP for patients in need
Entered billing for hospitalist patients with diagnosis codes
Delivered top-notch administrative support to office staff, promoting excellence in office operations.
Enhanced projects with efficient schedules, coordinated related documents and organized resources to support unique demands.
Secretary
Crouse Health Hospital
Syracuse, NY
Chemical Dependency Department
Scheduled appointments and conducted follow-up calls to clients.
Secretarial duties for the Day and Evening Treatment Counselors, to include answering phones, typing letters, weekly statistics and daily starts for groups
Compiled reports twice weekly to be faxed to the Syracuse Drug Treatment Court
Preparation of monthly attendance sheets, as well as daily logs for Evening Counselors
Special projects as assigned by Director, Floor Supervisor or immediate supervisor, to include completion and retention percentages, team building exercises and start ratios.
Created and updated physical records and digital files to maintain current, accurate and compliant documentation.
Administrative Assistant
United Way of Central New York
Syracuse, NY
10.2002 - 03.2004
Assisted with meetings for the Community Impact Cabinet, Developmental Task Force, FEMA board and other sub-committees, record meeting minutes and maintain official correspondence/document files
Designed, created and maintained numerous Access databases for Community Impact division
Assisted with the Combined Federal Campaign for local federal agencies, includes taking meeting minutes, organizing events, providing training and maintaining information in United Way database – ANDAR
Provided administrative support the Success by 6 initiative, including designing and maintaining Access databases, correspondence and meeting preparations, and mailings
Supported efficient meetings by organizing spaces and materials, documenting discussions and distributing meeting notes.
Covered reception area, assist with mass mailings, organizational events and other duties as required
Administrative Assistant
Manpower Inc
Dewitt, NY
02.2000 - 07.2002
Correspondence, reports, bid proposals, meeting and travel arrangements for the Area and Sales Managers
Executed record filing system to improve document organization and management.
Prepared financial information for Area Manager and Corporate Office on a weekly, monthly and quarterly basis
Assisted in the closure, relocation and establishment of branch offices
Interviewed applicants for permanent employment within area and branch offices
Handled accounts payable and receivable issues for area and select branch offices
Tracked worker compensation claim status within all branch offices, make recommendations regarding resolution
Processed payroll, employment changes for all permanent employees, including yearly compensation and incentive changes and quarterly incentive calculations
Monitored supervisor's work calendar and scheduled appointments, meetings and travel.
Supported room reservations, agenda preparation and calendar maintenance for programs, meetings and events.
Database Administrator
Manpower Technical
Dewitt, NY
11.1998 - 02.2000
Initial contact with applicants regarding resume, availability and specifics on salary, locations and job knowledge
Scanning and importing resumes into database for retrieval by recruiters
Handled processing of payroll, benefits and accounts receivables for branch
Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
Triaged incoming calls on multi-line phone system and directed to departments based on customer needs.
Administrative Assistant
Onondaga Employee Leasing
Syracuse, NY
03.1998 - 10.1998
Answered phones, order supplies, set up deliveries/pickups and maintained office equipment
Maintained database for tracking incoming clients, home closings and listings
Prepared individualized client packets about schools, homes for sale and general city information
Prepared bulk mailing for listings, closings and human resource activities
Education
High School Diploma -
Golden High School
Golden, CO
Skills
Software experience includes Microsoft Windows, Microsoft Outlook, Microsoft office (Excel, Word, Access, Powerpoint, Project and Publisher) Lotus Notes, Pagemaker, Filemaker Pro, Oracle and Helix
Typing speed 70 wpm
Operations support
Operations management
Process implementation
Employee reviews
Coaching and mentoring
Timeline
Supervisor , Healthcare Services Operationap Support
Laboratory Animal Caretaker at Upstate Medical University, Dept. of Laboratory Animal ResourcesLaboratory Animal Caretaker at Upstate Medical University, Dept. of Laboratory Animal Resources