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Open to workDesired start date: 2 weeks notice
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KIA HORTON
Bronx
Work Preference
Summary
Expert in coordinating patient care and managing operational workflows within healthcare environments. Proficient in scheduling, records management, and regulatory compliance, consistently enhancing service delivery and fostering collaborative relationships among interdisciplinary teams to optimize patient experiences. Proficient in Precision Care, 3M coding, EPIC, eClinicalWorks, Epaces, Salesforce, and reimbursement software. Ongoing preparation for the AHIMA RHIT exam while actively contributing as a member of the National Society of Leadership and Success.
Overview
18
18
years of professional experience
Work History
Clinical Support Coordinator
HEALTHFIRST
New York
05.2024 - Current
- Coordinated patient appointments, including scheduling tests, procedures and assessments.
- Answered incoming calls from patients regarding their care plans, or inquiries about authorizations.
- Demonstrated excellent customer service skills when interacting with patients and their families.
- Assisted clinicians with scheduling appointments and managing referrals.
- Documented medical records by entering patient interactions and information.
- Implemented patient satisfaction surveys to gather feedback and identify improvement areas in clinical services, enhancing patient experience.
- Managed electronic health record updates, ensuring accurate documentation and compliance with healthcare regulations.
- Collaborated effectively with interdisciplinary team members including physicians, nurses, social workers, case managers to coordinate services for patients.
- Verified data accuracy by cross-referencing with original sources and obtaining additional information.
- Analyzed and evaluated appeal cases for accuracy, completeness, and compliance with applicable laws, regulations, and procedures.
- Implemented best practices for appeals management, ensuring compliance with regulatory standards and streamlining appeal processes.
- Implemented crisis intervention protocols, significantly reducing patient wait times during emergencies.
- Maintained composure during high-stress situations to support patient needs.
Intake Coordinator
EMBLEM HEALTH
Remote
09.2022 - 02.2024
- Oversaw compliance with regulatory requirements during the intake process to ensure operational integrity.
- Processed paperwork and secured confidential information, ensuring compliance with privacy regulations.
- Identified and corrected data entry errors, enhancing data integrity across systems.
- Resolved escalated complaints and clarified policies, improving member and provider satisfaction.
- Resolved escalated complaints and answered questions regarding policies and procedures.
- Addressed and mediated member and provider grievances.
- Coordinated scheduling of peer reviews to ensure timely compliance with regulatory standards.
- Scheduled peer reviews in accordance with regulatory standards to ensure timely compliance.
- Streamlined single case agreement processes, reducing turnaround times for out-of-network provider approvals.
- Processed appeals for denied authorizations with thorough documentation support.
- Managed workflow processes for authorization requests, including routing documents and tracking progress.
- Reviewed and approved authorization requests according to established criteria.
Care Coordinator
COSAN GROUP
Remote
06.2022 - 09.2023
- Coordinated patient care with patient/caregiver, home health agency, and physician's office to establish therapy response, identify supply needs, and document adherence occurrences.
- Supported Enrollee in following treatment recommendations through health and wellness education and advocacy, fostering adherence to care plans.
- Maintained up-to-date scheduling/testing status boards in eClinicalWorks and Epic systems.
- Requested clinical information from relevant parties.
- Investigated and reported issues relating to patient care and conditions which might hinder patient well-being.
- Monitored vital signs and medication use, documenting variances and concerning responses.
- Assessed client needs and directed tailored interventions, ensuring appropriate care based on individual circumstances.
- Assisted clients in navigating the healthcare system by providing referrals for needed medical services.
Patient Services Specialist
MODERNIZING MEDICINE
Remote
05.2021 - 06.2022
- Served as primary contact for all inbound and outbound patient calls regarding patients' balance inquiries, claims processing, insurance updates and payment collections.
- Coordinated insurance authorizations, collected co-payments, and resolved discrepancies to ensure seamless patient experience.
- Answered 90+ telephone calls daily to schedule appointments and address patient inquiries.
- Processed payments from patients, including cash, check, or credit card transactions.
- Resolved billing disputes between patients and health insurers promptly to maintain positive relationships and patient satisfaction.
- Accurately input and update patient account information and document calls into PM.
- Utilized advanced billing software to optimize invoice generation and track payment history.
- Expertise in reconciling discrepancies between invoices, payments, credits and other documents.
Day Habilitation Counselor / Front Desk
UNITED CEREBRAL PALSY ASSOCIATION OF NEW YORK STATE
New York
04.2008 - 04.2021
- Assisted clients with identifying treatment and recovery goals and provided services for implementation.
- Performed assessments to determine individual limitations and strengths.
- Called Pharmacies to obtain medical prescription refills; documented medications into medical records.
- Modified instructions and activities according to each individual's abilities while encouraging participation in leisure time activities within the community.
- Provided supportive counseling services related to mental health issues such as depression or anxiety that may be impacting functioning at home or in the community.
- Arrange appointments and transportation for patients via the telephone.
- Scan medical and insurance files into the individual's electronic file.
- Verify individual's insurance coverage and obtain authorization.
- Utilized electronic health record systems for streamlined documentation and effective case management of client information.
- Maintained comprehensive clinical records and documentation of activities performed.
- Delivered supportive counseling services addressing mental health issues like depression and anxiety to enhance client functioning at home and in the community.
Education
Associate of Applied Science - Health Information Technology
DeVry University
New York, NY06-2025
Skills
- Insurance verification and claims processing
- Authorization management
- Health record management and electronic health records
- Intake assessment and data accuracy
- Appointment and schedule coordination
- Records management
- Customer interaction proficiency
- Patient communication
Accomplishments
- The National Society of Leadership and Success
Timeline
Clinical Support Coordinator
HEALTHFIRST
05.2024 - Current
Intake Coordinator
EMBLEM HEALTH
09.2022 - 02.2024
Care Coordinator
COSAN GROUP
06.2022 - 09.2023
Patient Services Specialist
MODERNIZING MEDICINE
05.2021 - 06.2022
Day Habilitation Counselor / Front Desk
UNITED CEREBRAL PALSY ASSOCIATION OF NEW YORK STATE
04.2008 - 04.2021
Associate of Applied Science - Health Information Technology
DeVry University