Darla Klose
Finleyville,PA
Summary
Experienced Health Care Professional ready to optimize patient outcomes through comprehensive oversight. Result oriented to meet departmental goals. Tracks and maintains organizational excellence charting through final discharge. Adept at building strong, constructive relationships with both patients and insurers to encourage uninterrupted service and payment. Hardworking administrative professional familiar with recordkeeping, mail management and data entry. Good at building relationships with healthcare staff, patients and provider representatives.
Overview
26
26
years of professional experience
Work History
Clinical Administrative Coordinator
Optum/ United Health Care
06.2017 - Current
- Provided comprehensive administrative support to department staff of 23.
- Reviewed cases to determine need for escalation.
- Maintained high-level knowledge of federal and State regulations on patient privacy.
- Maintained complete documentation for permanent records and auditing purposes.
- Performed patient census operations, collecting data to generate comprehensive profile of practice's performance.
- Assembled charts for new patients, confirming inclusion of requested medical history and diagnostic information.
- Investigated claims to check billing status
Sr Case Manager Level 2
MedPLUS/United Health Plans
09.1997 - 06.2022
- Made appropriate referrals, monitored client services in appropriate time frames, while keeping high performance measures. Documented services provided and completed departmental billing procedures.
- Teamed up with managers and executives to assist in evaluating and improving performance of direct services, contributing to strategic program planning and development.
- Communicated with supervisor regarding issues related to case management, resourcing, service collaboration and development of new resources.
- Served as case coordinator, assuming responsibility for complex, high-volume cases of over 300 assignments and guiding endeavors to successful completion.
Pregnancy Case Manager Level 2
United Health Care
02.2002 - 03.2017
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Developed and implemented comprehensive incentive plan for compliant members.
- Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
- Monitored clients' progress and tracked client services to provide crisis interventions.
- Developed and implemented safety plans for clients at risk of harm to provide protection.
- Participated and headed community events to promote services and engage with public of over 350 members.
- Assisted with developing new applications for vision impaired representatives.
- Assisted with continued education for team members.
Education
High School Diploma -
Clairton High School
Clairton, PaSome College (No Degree) - Phlebotomy/ Graduated Certificate
CCAC South Campus
Jefferson, Hills, Pa.Certified Medical Assistant
McKeesport Hospital Medical Assistant Program
McKeesport, PASkills
- Eligibility Verification
- Medical Office Management
- Medical Terminology
- Claims Assessments
- Documentation Skills
- Medicare/Medicaid
- Claims Management
- Insurance Verification
- Results and Goal driven
- Telephone Customer Support
Timeline
Clinical Administrative Coordinator
Optum/ United Health Care
06.2017 - Current
Pregnancy Case Manager Level 2
United Health Care
02.2002 - 03.2017
Sr Case Manager Level 2
MedPLUS/United Health Plans
09.1997 - 06.2022
High School Diploma -
Clairton High School
Some College (No Degree) - Phlebotomy/ Graduated Certificate
CCAC South Campus
Certified Medical Assistant
McKeesport Hospital Medical Assistant Program