Keri-Ann Castaldini

GSSC coordinator for SCO Fallon and BMC

schedule initial and ongoing assessments telephonically and in person

coordinate services for members and updating careplans

document all correspondence promptly and in appropriate databases

renew expiring careplans monthly

worked alongside SCO RNCM and Navigators to facilitate and coordinate services and order dme for members

provide contact with members and PRAs regularly to ensure needs have been met and members feel supported

reports cases to protective services as needed

Addressed family concerns promptly by collaborating closely with support services such as social workers or financial counselors

create and update spreadsheets

create careplans for new effectives

attend weekly supervision meetings with SCO manager to review caseloads

Renew Care Plans

Enroll/Dis-enroll consumers in appropriate database

make outreach calls to consumers

document all correspondence in appropriate database

Create and Send HTR letters

Consumer Outreach calls

Distribute faxes

Interact with providers to terminate/suspend services

Assist with missed HDM

Streamlined office operations by implementing efficient filing systems and digital document management.

• Maintained detailed understanding of insurance plans and company requirements
• Verify insurance eligibility
• Obtain authorization for psychiatry emergency and inpatient psychiatry services
• Ensure authorizations are entered correctly into Epic work queue
• Investigate and rectify discrepancies and denials
• Complete single case agreements on denials and out of network claims
• Obtain prior authorizations for electroconvulsive therapy
• Obtain prescription authorizations for psychiatry medications and Suboxone
• Collect co payments for outpatient practice
• Check patients in and out, schedule appointments, take messages for providers and other front desk tasks that may arise
• Update demographics in Epic
• Manage Excel spreadsheets
• Input details into accounts and tracked payments
• Responded to telephone and in person inquiries with friendly demeanor and full knowledge of billing department processes

• Acquired insurance authorizations for procedures and tests ordered by the attending physician
• Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered
• Efficiently performed insurance verification and pre-certification and pre-authorization functions
• Submit Workman's Compensation cases to insurance companies

• Connected callers with appropriate professional, department or business
• Announced important information and emergency notifications over PA system
• Trained new employees
• Page doctors and personnel
• Update schedules for each on call department
• Direct visitors and patients to appropriate departments
• Check doctors in and out
• Responsible for initiating Codes and making sure appropriate personnel makes it to correct location