KATHLEEN JULIAN

• Applied effective time management techniques to meet tight deadlines.
• Skilled at working independently and collaboratively in a team environment.
• Strengthened communication skills through regular interactions with others.
• Self-motivated, with a strong sense of personal responsibility.
• Proven ability to learn quickly and adapt to new situations.
• Paid attention to detail while completing assignments.
• Developed and maintained courteous and effective working relationships.
• Stayed current with latest changes to applicable regulatory standards and company procedures.
• Developed and implemented corrective action plans for non-compliance issues.
• Maintained composure in stressful situations, confrontations, interviews and records searches.
• Conducted periodic compliance audits and reviews to identify areas of improvement.

Note: No break in service from job below - only change in position.
Utilized strong assessment skills to determine medically necessary treatment(s) for retro claims review.
Kept abreast of advances in computerized technology, word processing skills, government regulations, health insurance changes, with a thorough understanding of CMS, AHCCCS, and MCG.
Review and apply correct coding by using 3M DRG Grouper/Pricer software
Review and make determinations on OPS and DRG appeals for medical Disciplined, energetic employee who quickly establishes rapport with others. Evaluated accuracy and compliance of all documentation. Review itemized bill for exclusions to ensure accurate billing Utilize clinical skills for approval of claims by chart review, physician communication, Retro Review Tool created and based on the ACEP ED Facility Coding Guidelines, and Interqual standards

Ensured appropriate utilization and cost effective, medically necessary care; review, authorize, coordinate and respond to requests for services for members from providers. Frequent telephone contact with provider’s office to coordinate services and make authorization decisions based on established policies and procedures set in the company guidelines and using InterQual guidelines. Participated in quality improvement by measuring, assessing, and improving performance in order to impact the overall quality of clinical and support activities/processes. Maintained internal and external confidence, protect operations and ensure quality service by upholding predefined quality standards, following company policies and procedures and adhering strictly to HIPAA guidelines.

Almost 3 years experience

• Used aseptic techniques to provide sterilized wound care and dressing applications.
• Performed routine evaluations of each patient's status, needs, and preferences.
• Educated patients and caregivers on medical diagnoses, treatment options, chronic disease self-management and wound management.
• Answered incoming phone calls from patients to provide basic assistance and triage medical concerns.
• Cared for wounds, provided treatments, and assisted with MOHS procedures.
• Assessed patients' temperature, pulse, and blood pressure and recorded in electronic medical records.
• Reviewed patient history to verify conditions and current medications.
• Carried out HIPAA adamantly

Four-and-a-half (4.5) years experience

• Worked effectively in fast-paced environments.
• Demonstrated strong organizational and time management skills while managing multiple projects.
• Excellent communication skills, both verbal and written.
• Developed and maintained courteous and effective working relationships.
• Skilled at working independently and collaboratively in a team environment.