Grace Speth
Montrose,Ca
Summary
Highly motivated individual seeking a responsible position where work experience, skills and education will be immediately utilized.
Overview
9
9
years of professional experience
Work History
Care Coordinator
All Care Palliative Care
Glendale, CA
02.2022 - 10.2023
- Received case referrals from LA Care Health Plan - Medical and reviewed patient's information
- Coordinated admission, follow-up, recertification and discharge visits with clinical staff
- Managed multiple calls per day
- Monitored completion and QA of clinician's notes
- Created, submitted Plan of Care to PCP and monitored return of signed POC
- Obtained patient care authorizations (initial, reauthorization) from LA Care UM department in a timely manner
- Requested, followed-up supplies, DME and medical referrals from PCP and monitored approval and denial
- Reported to PCP and LA Care PC team patient's updates and concerns
- Assisted in staffing patients
- Called patient weekly to check and addressed concerns
- Provided medical records request
- Prepared monthly IDT report and participated in monthly IDT meeting with All Care Palliative Medical Director and All Care Palliative Director of Nursing
- Attended monthly LA Care Palliative Care meeting, discussed patient issues and concerns
- Performed other duties as directed by Director of Nursing
Asst. Care Coord. for Authorization/Care Coord.
Comcare Home Health/All Care Home Health
Glendale, CA
11.2016 - 09.2021
- Obtained authorization for patient care of Kaiser Permanente - Los Angeles region members in timely manner.
- Worked closely with clinical teams regarding current and future authorization needs
- Other duties as assigned
- Received case referrals
- Reviewed available patient information related to case, including disciplines ordered, to determine home care needs
- Coordinated clinician's visit
- Followed-ups notes, DME and supply orders
- Assisted with staffing whenever needed
- Performed other duties as directed by Director of Nursing
Health Risk Assessor
APS Healthcare
06.2014 - 06.2016
- Contacted members of LA Care (Cal Medi Connect and SPD), on behalf of their Health Plan and completed Health Risk Assessments telephonically with members, after confirming that members are eligible for services through verification of plan eligibility, plan coverage and APS responsibility for HRA Completion
- Conducted face-to-face HRA to LA Care Cal Medi Connect members along with supervisor and completed HRA on C3 operating system
- Met internal and external timeliness criteria by completing HRAs in timely manner, including generation of customer communication materials and completed timely documentation on C3 operating system
- Requested mailing of paper HRAs and completed mailed HRAs received from members
- Handled incoming calls and made appropriate referrals, as necessary, to supervisor or to other departments
- Complied with Customer Service expectations as applicable to Department and Health Plan and complied with all departmental policies and procedures
- Complied with all guidelines established by Centers for Medicare and
- Medicaid (CMS) and guidelines set by other regulatory agencies, where applicable, and defined in company’s corporate and department policies
- Complied with all duties assigned by manager and/or supervisor
- Received multiple Certificates of Achievement for completing highest activities
Education
Medical Billing CPB Course
AAPC
03.2024
Vocational - Nursing
Glendale Career College
Glendale, CA10.2013
Bachelor of Science - Accountancy
Sacred Heart College
Lucena City, Philippines03.1996
Skills
- Medical terminology
- Nursing background
- Documentation
- Quality assurance
- Care Coordination
- Patient education
- Organizational skills
Timeline
Care Coordinator
All Care Palliative Care
02.2022 - 10.2023
Asst. Care Coord. for Authorization/Care Coord.
Comcare Home Health/All Care Home Health
11.2016 - 09.2021
Health Risk Assessor
APS Healthcare
06.2014 - 06.2016
Medical Billing CPB Course
AAPC
Vocational - Nursing
Glendale Career College
Bachelor of Science - Accountancy
Sacred Heart College