Kelvin Jones
McDonough,GA
Summary
Motivated patient support professional experienced working in challenging environments demanding strong organizational, technical, and people skills. Initiative-taking, trustworthy, and dependable; committed to superior patient care. Extremely meticulous and analytical in the completion of tasks, able to multitask effectively maintain professionalism under pressure. Thrives in deadline-driven environments with excellent team-building skills. Compliant with all healthcare facilities, HMO/PPO, and insurance requirements, OSHA and HIPAA trained. Professional Skills include: Hospital Case Management, Denials Management, Revenue Cycle, Pre-Certification, Data Entry, Inpatient/Outpatient Surgery Scheduler, Charge Entry, Medical Terminology, Front-Office Operations, ICD-9/ICD-10, Clinical Order Entry, Allscripts, Millennium/Power chart, Moon and IMM. Microsoft Office, EPIC, CMS,Medicaid, Discharge Planning, InterQual, Wellsky.
Overview
14
14
years of professional experience
Work History
Care Management Assistant
Piedmont Eastside Medical Center
11.2023 - Current
- Enhanced patient care by efficiently coordinating case management processes and collaborating with healthcare professionals.
- Delivery of patient Important Medicare Message Letters and Medicare Outpatient Observation Notice to patients and family within timeframe required by CMS Guidelines.
- Improved patient outcomes with thorough assessment, planning, and advocacy in case management process.
- Assisted in reducing hospital readmissions by effectively monitoring and following up on discharged patients'' progress.
- Contributed to efficient discharge planning, working closely with social workers and other team members to secure appropriate post-hospital care arrangements.
- Assist care managers in removing non-clinical barriers to discharge and securing post-acute care from inpatient setting.
- Supports post-acute referral process to external providers such as acute rehabs, skilled nursing facilities, home health,hospice, DME, etc.
Sr. Clinical Administrative Coordinator
UnitedHealth Group/Optum
01.2023 - 09.2023
- Initiate urgent skilled nursing facility cases by reviewing clinical received via telephone, and fax.
- Accurately input clinical into EPIC, electronically route cases to um nurse for review and decision.
- After decision, is responsible for accurate case completion to include generation of approval letters while staying within compliance with time limits.
- Follow department policy regarding accurate documentation of clinical data, demographic and, provider / facility contract status, appropriately route cases to RN for clinical review, follow departmental policy for non – clinical level notifications.
- Provide prominent level of customer service while communicating with internal departments and provider office staff as pertains to performance of responsibilities.
- Takes responsibility for problem solving to achieve key indicator goals.
Case Management Specialist / Epic Software Trainer
Emory Healthcare At Emory St. Joseph's Hospital
11.2018 - 08.2022
- Initiate all inpatient, observation, and elective admission accounts.
- Identify correct insurance plan, financial class, and coordination of benefits.
- Processes out-of-network requests and notify Case Manager immediately.
- Obtained clinical authorization by communicating patient and clinical information, medical necessity, and level of care to payers.
- In addition to continued stay and scheduled admissions when payers require current clinical information beyond initial days authorized.
- Receive patient information from team of Care Managers and Financial Counselors to secure identified patient accounts within 24 hours of admission according to payer requirements.
- Enter authorization documentation, prioritize work for optimal reimbursement and to avoid financial risk to both patient and facility.
Referral Coordinator
Atlanta Gastroenterology
08.2017 - 11.2018
- Schedule, reschedule, and manage cancellations and no shows for patient office visits and procedures.
- Maintain and update information on physicians' schedules and endoscopy block time.
- Schedule patients according to physician availability and preference, collect and record accurate patient information according to AGA documentation Requirements.
- Coordinate scheduling of procedures in hospital.
- Cross train and perform other office functions including phone triage, scheduling, and pre-certification.
PA Rep II/Epic Software Trainer
WellStar Health System
03.2016 - 08.2017
- Obtained authorizations for emergency room admissions and inpatient/observation hospitalizations.
- Accurately verify patient's benefit information online or via telephone, Secure Inpatient visit notification with insurance payer, contact utilization management for discharge dates as needed to complete authorization and avoid denials, update insurance policy information in EPIC system as required.
- Review and match clinical data against medical terms and diagnoses follow procedures to receive authorizations, ability to follow through to completion on all assignments and meet deadlines.
Physician Office Specialist/Epic Software Trainer
Ohio Health Riverside Hospital
04.2010 - 03.2016
- Register, check-in and check-out incoming patients of ambulatory clinics, POS collections and past due balances.
- Oversee front-office operations and provide impeccable customer service Scheduled appointments and maintained accurate up-to-date confidential medical files.
- Administer quality assurance surveys to improve patient care.
- Conduct patient interviews to obtain necessary information for registration, accurate prioritization, and assist medical professionals in triage process.
- Assist in interviewing and training new hires on company policy, procedures, and departmental workflow.
Education
Bohecker College
Westerville, OH02.2009
Skills
- Case Management
- Analytical Thinking
- Quality Assurance
- Interpersonal Skills
- Attention to Detail
- Case Planning
Affiliations
- ACMA
Timeline
Care Management Assistant
Piedmont Eastside Medical Center
11.2023 - Current
Sr. Clinical Administrative Coordinator
UnitedHealth Group/Optum
01.2023 - 09.2023
Case Management Specialist / Epic Software Trainer
Emory Healthcare At Emory St. Joseph's Hospital
11.2018 - 08.2022
Referral Coordinator
Atlanta Gastroenterology
08.2017 - 11.2018
PA Rep II/Epic Software Trainer
WellStar Health System
03.2016 - 08.2017
Physician Office Specialist/Epic Software Trainer
Ohio Health Riverside Hospital
04.2010 - 03.2016
Bohecker College
Similar Profiles
Cierra BlankCierra Blank
Stroke/STEMI Manager at Piedmont Eastside Medical CenterStroke/STEMI Manager at Piedmont Eastside Medical Center
Marlon CoakleyMarlon Coakley
Dietary Services Supervisor at Piedmont Eastside Medical CenterDietary Services Supervisor at Piedmont Eastside Medical Center
Naahily AhmedNaahily Ahmed
Postpartum Registered Nurse at Piedmont Eastside Medical CenterPostpartum Registered Nurse at Piedmont Eastside Medical Center
Cara SmithCara Smith
Registered Nurse, Medical-Surgical Unit at Piedmont Eastside Medical CenterRegistered Nurse, Medical-Surgical Unit at Piedmont Eastside Medical Center
Olly WhisenhuntOlly Whisenhunt
Administrative Staff Member at Davies General Contracting LLCAdministrative Staff Member at Davies General Contracting LLC