Nicole Kosugi
San Diego,CA
Summary
To find a career opportunity that will utilize my current skill set, afford me the opportunity to develop new skills, and reward my hard work with opportunities for career advancement. Proactive Clinical Coordinator excited to transition into a new position where superb leadership and clinical coordination abilities can be utilized.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Clinical Services Coordinator
Blue Shield of California Promise Health Plan
10.2018 - Current
- Support UM manager and UM department activities
- Screen incoming authorization requests for all departments
- Enter 40 authorization requests per day
- Manage online patient and provider portals for authorizations
- Handling of member inquiries.
- Implemented new policies and educated staff on changes.
- Report analysis for compliance with DHCS and CMS regulatory audits
Utilization Management Coordinator
Care 1st Health Plan
02.2015 - 10.2018
- Support UM manager and UM department activities
- Screen 50 incoming authorization requests, specifically for Cal-Mediconnect patients and verified eligibility
- Enter authorization requests for skilled nursing facilities and transportation as needed
- Fax and mail Last Covered day letters, denial letters and authorization approvals
- Fax, organize, and file all medical records requests for long term care members, and care transition records
- Create, and distribute for approval, workflows for authorization, request for records and care transitions processes for CCI department.
Assistant Office Manager/Receptionist
Integrative Health Solutions
11.2009 - 01.2015
- Schedule and greet new and existing patients
- Manage multiple phone lines, answer patient inquiries
- Reminder calls for patient appointments
- Create new files and patient charts
- Draft letters for patients
- Responsible for patient billing and filling out insurance authorization requests
- Fax, email and other office duties as assigned.
- Manage back office inventory
Education
AA of applied Science in Medical Assisting -
Argosy University
San Diego, CA01.2009
Skills
- Excellent Organizational Skills
- Strong Customer Relations skills
- ICD-10 CPT Coding and referral processing
- Computer Proficiency (Microsoft Word, Outlook, PowerPoint and Excel)
- Medical database expertise
- Utilization Process Implementation/Improvement
- Quality Assurance Controls
- Regulatory Requirements
- Data Analysis
- Healthcare administration/Health Information Systems
- Staff Supervision
- Patient services management
- Research coordination
- Training and mentoring
Certification
CPR and AED certified
References
Available upon request
Timeline
Clinical Services Coordinator
Blue Shield of California Promise Health Plan
10.2018 - Current
Utilization Management Coordinator
Care 1st Health Plan
02.2015 - 10.2018
Assistant Office Manager/Receptionist
Integrative Health Solutions
11.2009 - 01.2015
AA of applied Science in Medical Assisting -
Argosy University
CPR and AED certified
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