Lovie Byrd

• Under the direct supervision of a Social Work Supervisor Level IV working in Ambulatory Care Service clinics and worked closely serving chronically ill patients in a Case Management capacity, linking patients to primary medical care, facilitating & linking to Public Benefits, Transportation (Access a ride/MAS/alternative transportation modes), SSI, SSD benefits, Housing, Community resources, Legal assistance, assisted living & shelter placements, facilitated process of obtaining Durable medical equipment, worked with local CBO's in conducting community based outreach and center-based screening, intake and assessments with particular emphasis on patient's needs and strengths
• Management of the NYLAG legal clinic in scheduling appointments and assessing patient's eligibility for services
• Facilitated educational workshops with vendors, community agencies to promote a learning forum for social work staff

• Served as the contact person, advocated and serves as an informational resource for patients, care team, family/caregiver(s), payers, and community resources
• Work with patients to plan and monitored care
• Developed a care plan with the patient, family/caregiver(s) and providers (emergency plan, health management plan, medical summary, and ongoing action plan, as appropriate)
• Monitored adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner, and facilitated changes as needed
• Created ongoing processes for patient and family/caregiver(s) to determine and request the level of care coordination support they desire at any given point in time
• Assisted patient in applying for housing, Public assistance, Snap benefits, and SSI/SSD/ SSDI
• Scheduled primary care visit and specialty visit to ensure optimal care and compliance
• Facilitate patient access to appropriate medical and specialty providers
• Educated patient and family/caregiver(s) about relevant community resources
• Facilitated and attended meetings between patient, family/caregiver(s), care team, and community agencies to promote a learning forum for social work staff
• Cultivated and supported primary care and specialty provider co-management with timely communication, inquired, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals, Case conference between medical provider, social worker, health insurance, and or specialty departments to ensure patient receives required level of care
• Attend all Care Coordinator training courses/webinars and meetings
• Provide feedback for the improvement of the Care Coordination Program

• Engaged members/caregivers in a collaborative relationship, empowered them to manage their physical, psychosocial and environmental health to improve and maintain optimal health
• Screened over 200 member's daily according to MetroPlus Health Plan policies and procedures, assisted members in identifying appropriate support activities and services to maximize health and wellness
• Advocated for members by assisting them to address goals and interventions, and make informed choices regarding the use of social and other community supports
• Assisted members in understanding mechanics and management of health care and social support networks
• Assisted members in research and understanding of benefits and claims information and resolutions
• Performed non-clinical activities for members of various ages, clinical scenario, culture, financial means, social support, and motivation

• Oriented newly assigned members and reorients existing members to MetroPlus Health Plan and the scoop of services the plan provides as needed
• Ensures, formulates and validates an individualized plan of care utilizing various databases and collateral resources such as the member, caregiver, primary care provider, and or community level case manager to identify the needs and barriers of members living with HIV in order to promote the health and wellness of the member
• Ensures that the Plan of Care identifies appropriate goals and interventions
• Performs telephonic case management activities where needed, including care coordination, planning for transition of care, outpatient follow up and ancillary services review throughout the continuum of care to ensure optimum health outcomes
• Provides health education on HIV disease, HIV primary and secondary risk reduction and other comorbid illnesses, such as hepatitis C, diabetes and hypertension as indicated by the Plan of Care
• Coordinate with providers to assure co-morbidities were address and followed up along with HIV needs such as (Asthma, Diabetes, high blood pressure and or high cholesterol)
• Maintained database of member’s blood work and monitor levels of CD4 counts and viral loads to ensure adherence to medication

or over Requested medical records and clinical reviews to ensure providers obtained notice of approval or denial for services rendered

• Process high volumes of data information based on information received in order to effectively ensure quality of care for the members
• Collaborated with onsite medical doctors, register nurses, and social workers to develop optimal level of care
• Received clinical documentation for durable medical equipment and process (approved or denied) based on medical necessity
• Collaborated with venders to place emergency response systems in members' homes for safety purposes and to ensure timely EMS responses to emergent situations
• Authorized services for Adult Day Health Care for disabled and elderly members
• Scheduled team meeting to address new processes with work flows and new lines of business

• Processed medical forms and verification of medical information for clients received via fax
• Answered ACD lines to certify inpatient admissions, ambulatory admissions, and mommy baby admissions as well as DME for authorization
• Entered clinical information into various databases such as systems Canopy, Unity, and Care Connect
• Liaison between RN Case Managers, outreached Social Workers & Special Needs Programs for connectivity to care for Metroplus members
• Extensive data entry and clerical duties as needed, process & filing of patient faxes

• Conducted investigations in NYC Health + Hospitals facilities to determine the eligibility of applicants for medical assistance payment programs, or the ability of patients and their legally responsible relatives to pay for hospital or health care charges and take the necessary actions to bill and collect for these services; explored alternative sources for payment of hospital or health care services rendered; verify, modify and code demographic and insurance data obtained from source documents, and accurately enter such data into computerized system(s) ensuring compliance with payor rules and regulations; performed billing and collection functions; complete and/or review paper and electronic claims for proper and timely submission to insurance carriers; follow up with insurance carriers, employers and/or patients for prompt payments; monitor and track denials and underpayments received from insurance carriers; complete non-clinical appeals when necessary; escalate accounts to supervisor in a timely manner in order to obtain maximization of a hospital's or health care facility's revenue
• Completed Medicaid applications for NYC and Westchester Counter for patients with an inability to pay for medical services rendered