Markus Carroll
Huntington Beach,CA
Summary
Healthcare Care Coordinator with proven to deliver exemplary level of healthcare service delivery to patients. Coordinate admission and discharge of patients. Plan and implement strategies for developing improved health care management. Proven problem solver and excellent communicator. Strong organizational skills, superb understanding of data collection and performance metrics. Recognized for staff development leading to high performing teams.
Overview
9
9
years of professional experience
Work History
Care Worker
Magellan Health
06.2023 - 12.2023
- Facilitates department workflow by supporting clinical team with administrative care coordination support
- Establishes and maintains positive work relationships with current referral sources, screenings, and assessments, ensuring precision in member referral processes
- Locates community services and other referral locations for enrollees, arranges access to care, support communication with hospital, and providers
- Entry of references and authorizations to database, coordination of follow-up with the reference doctors approved by a physician associates’ doctor
- Evaluate and authorize approval prior authorization requests daily using client clinical criteria and prior authorization by communication with managed care Plan Providers
- Determine the appropriateness of patients’ medications by communication selected prior authorization criteria, benefit coverage, and formulary alternatives to various medical professionals
- Follows State Contract Medicare/Medicaid (Medi-Cal) rules and regulations with Privacy/HIPPA.
Care Coordinator
Southwestern Health Resources
10.2019 - 05.2022
- Processes and completes referrals as directed by Primary Care Providers following departmental protocols and expectations
- Communicate all progress and issues with manager
- Utilizes exceptional care coordination skills to communicate with patients, referring and service providers and clinical staff to complete referrals, prior authorizations accurately and expediently to minimize errors and reduce delays in care
- Messages primary care providers or designated clinic staff all patient care related concerns or relevant information, redirecting clinical conversations to clinical personnel
- Communicating all progress and issues with manager working on special projects and following State Contract Medicare/Medicaid, (Medi-Cal) rules and regulations with Privacy/HIPPA
- Communicating patient care needs to appropriate Care Coordination team members following protocols set by management
- Maintaining the Salesforce queue assigned to by management; making outbound calls as determined by business needs, updating patient demographic information, insurance information & preferred contact information, as needed.
Reimbursement Counselor
AmerisourceBergen
07.2014 - 03.2019
- Initiated processing of prior authorization requests for services and routing to appropriate staff clinical team
- Reviews service requests, collects data, and recommends service levels in accordance with established policies related to state and federal guidelines
- Expertise in Utilization and Case Management (including assessment, processes, procedures, care plans and reimbursement principles)
- Responsible for gathering, reviewing, and submitting all necessary insurance information to ensure that claims are processed in timely manner as required by all third-party payors
- Patient Reimbursement Counselor also aids physician office staff and patients to complete and submit all necessary insurance forms and program applications.
Education
Associate in Applied Science - Business Administration
Central Piedmont Community College
Charlotte, NC05.2023
Skills
- Type 50WPM
- Proficient with Microsoft Office 365
- Attention to Detail
- Excellent time management skills
- Excellent customer service and soft skills
- EMR Healthcare Systems
- ICD-10 Codes
- Care Plan Management
- Insurance Practices
- Records Maintenance
Timeline
Care Worker
Magellan Health
06.2023 - 12.2023
Care Coordinator
Southwestern Health Resources
10.2019 - 05.2022
Reimbursement Counselor
AmerisourceBergen
07.2014 - 03.2019
Associate in Applied Science - Business Administration
Central Piedmont Community College