Janis Clark
Richmond,VA
Summary
Polished professional manages multiple tasks, utilizes electronic medical record systems, and provides excellent customer service to patients and staff. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality.
Overview
12
12
years of professional experience
Work History
Medical Management Specialist II
Anthem
05.2020 - Current
- Gather clinical information regarding cases and determines appropriate areas to refer or assign case (utilization management , case management , QI, Med Review)
- Reduced hospital readmission rates through careful monitoring of patient progress and proactive follow-up measures.
- Maintain and updates tracking database
- Strong Client- facing orientation
- Provide non clinical support to medical management operations
- Customer service skills
- Prepare reports and documents
- Peer training
- Hedis
Utilization Management Admin II
Humana Inc
08.2018 - 01.2020
- Provide a high standard of customer service and would meet/exceed 50+ cases per day
- Reduced wait times for essential services by effectively managing utilization review caseloads and prioritizing urgent requests.
- Proactively identified potential barriers to effective service delivery, working closely with clinical teams to address issues before they impacted patient outcomes.
- Creates, updates, maintains, and/or closes authorizations or tasks for services as assigned within process guidelines
- Delegated current processes to make more efficient and effective for shift productivity for dedicated provider
- Quality Improvement Organization, all complaints and quality of care reviews to ensure consistency in the review process
- Appeals
- Transcribe Physicians orders.
- Presented findings from utilization reviews to leadership teams, informing data-driven decision-making on resource allocation initiatives.
Medical Records Technician
NCI Information Systems Inc.
11.2013 - 04.2018
- Received, process, clean and sort incoming mail in order to review and validate Quality Control for accuracy support
- Team Lead
- Demonstrated strong attention to detail while cross-referencing medical records for completeness and consistency, identifying potential errors and facilitating prompt resolution.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Maintained strict confidentiality of sensitive patient information in compliance with HIPAA regulations.
- Achieved high levels of accuracy while inputting clinical data into EHR system as well as manual charting methods when necessary.
- Analyzed data on patient outcomes to identify areas for improvement in service delivery and resource allocation.
- Transcribed and entered patient medical information into electronic medical records systems.
- Sorted and distributed incoming and outgoing medical records.
IT Associate Specialist
General Dynamics
09.2012 - 10.2013
- Medicare and Health Insurance Marketplace Trained
- Assisted customer with health insurance plans
- Complied with HIPAA Law and regulations to protect client confidential information
- Provided high-quality customer service and accurate information to Medicare Beneficiary
- Provided comprehensive technical support and training to end-users, fostering improved productivity levels.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
Education
Bachelor of Science - Health Administration
University of Phoenix
Tempe, AZ12.2027
Skills
HIPAA Compliance
Healthcare Analytics
Microsoft Office
Insurance Verification
Utilization review
Customer Service
Electronic Health Records
Microsoft Excel
EMR Systems
Attention to Detail
Multitasking Abilities
Excellent Communication
Timeline
Medical Management Specialist II
Anthem
05.2020 - Current
Utilization Management Admin II
Humana Inc
08.2018 - 01.2020
Medical Records Technician
NCI Information Systems Inc.
11.2013 - 04.2018
IT Associate Specialist
General Dynamics
09.2012 - 10.2013
Bachelor of Science - Health Administration
University of Phoenix
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