Kyona Wright

• Enforced HIPAA practices to keep patients' PHI safe

• Provide referral results, appointment disposition back to referring provider
• Provide referral management to oversight within command
• Monitor incoming/ outgoing referral request to ensure that specialty referral access to care standards are met
• Maintain gauge on access (capability/ capacity) at other's in National Capital Region
• Educate beneficiaries about MTF or network status referral, how to schedule appointments, etc
• Use CHCS to push referrals out to network, and close out when need be
• Use TOL Secure Messaging system to respond to incoming messages coming from Providers & Nurses within the clinic
• Monitor referrals for multiple clinics in Navy Medicine
• Update and change referrals on Humana website
• Coordinates, facilitates research, and communicates with requesting internal and external providers and managed care staff ensuring complete medical information is available for referral decision making and obtaining additional information as required for consult closure and clarification of care.
• Ensures all consults are transmitted within established guidelines via Referral Management Suite (RMS) or manual fax.
• Performs timely and accurate referral review, processing and tracking for administrative, clinical completeness and appropriateness; collaborates with internal and external healthcare, managed care and clinical stakeholders ensuring required use of Direct Care system and civilian network resources
• Demonstrates proficiency in utilizing CHCS, AHLTA, and RMS
• Reviews referrals for administrative completeness and researches covered benefits prior to processing.
• Provide referral results, appointment disposition back to referring providers.
• Use AHLTA to check, add & update records in patient chars by scanning or typing
• Complete skilled administrative work to support all office staff and operational requirements
• Contact hospitals and network providers to obtain patients medical histories reports
• Orients and trains new staff about referral processes and timeliness
• Reviews all referrals for administrative, clinical completeness and appropriateness
• Check patient eligibility for services and arranges and schedules medical appointments for referred care.
• Answers main office phone line(s). Directs telephone calls to appropriate section for assistance, handles independently or takes messages as required.
• Obtains documentation as requested by healthcare providers (test results, or documentation not yet filed in records).
• Utilizes referral tracking data collection tool. Calculates metrics, and compiles monthly reports, as directed by MTF.
• Identifies required tests, labs, radiology studies and other pre-requisites specific to each assigned specialty/product line prior to being dispositioned
• Disposition referrals out to network if capacity at MTF

• Supervising and coordinating staff including recruiting, selecting, training, and monitoring/ resolving staff issues and conducting performance reviews
• Helping with HR Duties such as informing applicants of job details and processing paperwork
• Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.
• Monitoring unit activities and workloads and allocating work.
• Participating in strategic planning for operational activities of area.
• Developing and implementing administrative systems and processes.
• Leading and/or participating in development and implementation of policies and procedures.
• Overseeing financial and human resource activities
• Organizing and leading special event planning including
  conferences and workshops.
• Helped distribute employee notices and mail around office to over 10 departments
• Managed office supplies, vendors, organization and upkeep
• Answered inquiries and addressed, resolved or escalated issues to management personnel to ensure client satisfaction
• Opened and properly distributed incoming mail
• Trained Staff on all duties
• Solving Medical Billing Issues
• Immediately addressed issues with customers so that could be successfully resolved
• Making sure all Money Reports were done on daily basis
• Answered and managed incoming and outgoing calls while
  recording data
• Making sure all staff positions were covered on daily basis.
• Handled various accounting transactions
• Compiled company information and related material and
  distributed it to candidates
• Provided clerical support to company employees, including copying, faxing and file management.