Priscilla Abdullah
Aurora,CO
Summary
Healthcare experience with 20 years offering solid foundation in analytical thinking and meticulous attention to detail, ready to learn and grow in this role. Contributes understanding of medical terminology and regulatory guidelines, paired with ability to assess data and documentation efficiently. Ready to use and develop analytical and problem-solving skills.
Overview
20
20
years of professional experience
Work History
Disability Examiner
State Of Colorado Department Of Human Services
03.2019 - Current
- Improved disability claim processing efficiency by applying thorough knowledge of Social Security Administration policies and procedures.
- Demonstrated adaptability when faced with policy changes or new legislation affecting the evaluation of disability claims, adjusting processes as needed without sacrificing accuracy or efficiency.
- Expedited decision-making process for disability claims by effectively managing a high-volume caseload under strict deadlines.
- Assisted in the development of internal policies and procedures, contributing valuable insight from years of experience as a Disability Examiner.
- Served as a mentor to new hires during their orientation and training period, sharing expertise and providing guidance to ensure a successful transition into the role.
- Handled sensitive personal information with discretion while adhering to strict confidentiality guidelines set forth by the Social Security Administration.
- Assisted claimants in understanding their rights and responsibilities throughout the application process, enhancing customer satisfaction levels.
- Fostered a positive work environment through active participation in staff meetings, trainings, and professional development opportunities.
- Provided guidance to other examiners on interpreting various disability laws and regulations, ensuring consistent application across all cases.
- Reduced error rates by consistently applying critical thinking skills to analyze and interpret complex medical records and test results.
- Recognized for exceptional performance through numerous awards and accolades, reflecting dedication to quality service and commitment to excellence within the field of disability evaluation services.
- Conducted comprehensive file reviews for quality assurance purposes, identifying areas for improvement within the department''s decision-making processes.
Referral Coordinator
Denver Health Medical Center
01.2016 - 10.2019
- Company Overview: Employed with organization in 2013
- Working on a team of 15 to coordinate members care for visits and procedures with providers that are in and out of network with members plan
- Goal is to review 100+ daily incoming authorization requests and provide decisions to providers and members within a regulatory time frame
- Triage incoming calls, emails, and letters to correctly identify the appropriate category of complaints, authorization requests, grievances and appeals for DHMP, DH/POS, CHP+, DH/MCD CHOICE, DH/MCD SELECT, DH/ MCR CHOICE, And DH/MCR SELECT
- Assist with updating all written materials including but not limited to member letters, Policies and Procedures and member handbooks in order to maintain proper procedures for authorization requests
- Also to ensure compliance with the accrediting and regulatory agencies
- Ensure all regulations governing member authorization request are implemented timely and accurately
- Perform duties to support Denver Health Medical Plan by reviewing, analyzing, and auditing information in order to follow all LOB when making a decision
- Ensures confidentiality of patient information by creating and maintaining a secure and trusting environment by not sharing information learned on the job, except when necessary in the performance of the job responsibilities or to improve a patient’s care
- Responded to patient inquiries to offer timely updates regarding referral status.
- Maintained a high level of accuracy in referral documentation, ensuring smooth transitions between healthcare providers.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Demonstrated strong attention to detail and organizational skills in managing a high volume of referrals while maintaining exceptional levels of patient care.
CSS III
Denver Public Health
01.2014 - 01.2016
- Manage patient flow in fast paced clinic setting
- Investigate and complete billing issues
- Cash handling and cash deposit
- Worklist management
- Monitor inbound calls from patients, physicians and other State Health Departments
- Data entry for outpatient lab tests
- Knowledge in Infectious disease within public health setting
- Use of HealthDoc, Lifelink scheduling, Invision and EDM
- Responded to queries from all external and internal insurance parties
- Created data sheets on different protocols and practices within the clinic
- Gathered data from different sources to be used for Grant and research projects
- Participated in LEAN projects for the clinic
Internship for Metropolitan State College
Denver Public Health
01.2014 - 01.2015
- Created Sharepoint site under preceptor supervision
- Managed site for Denver Public Health
- Managed calendar for upcoming events for employees
- Took part in monthly meetings to discuss other Sharepoint usage hospital wide
- Created site action plan that was updated regularly
- Owner of site until EPIC roll out April 2016
- Commitment to various projects throughout Denver Health
CNA Float Pool
Denver Health Main Campus
01.2013 - 01.2014
- Assists professional nursing and care providers in providing care to all patients with respect for their uniqueness
- Maintained unit specific documentation as required
- Knowledge of and the ability to use medical equipment and instruments to administer patient care
- Participated in committees aimed towards patient satisfaction
- Participated in readiness for Joint Commission
- Skill in establishing and maintaining effective working relationships with patients, employees, physicians and the public
- Ability to maintain quality control standards
- Ability to react calmly and effectively in emergency situations
- Ability to interpret, adapt and apply guidelines and procedures
Cardiology Tech (Agency)
Kaiser Permanente
01.2012 - 01.2013
- Manage daily appointments with patients needing to wear Holter/Event monitors for various time periods
- Obtain EKG monitoring reports for various providers paying close attention to critical Heart rhythm readings
- List of duties included obtaining daily reports and issuing them to the correct providers, maintaining monitor equipment and supplies performing daily appointments as well as add in appointments throughout the business day
- Function daily tasks with various computer programs including EPIC, Microsoft word, Excel and power point
- Possess knowledge in use of fax machine, Gmail, Medicomp systems and office telephones
Unit Coordinator/PCT
Saint Joseph Hospital
01.2005 - 01.2012
- Assisted with medical orders as well as computer functions including Meditech and EPIC
- Provided care for multi-unit patients including emergency/trauma, pediatrics, medicine, oncology and surgical
- Knowledge in hospital equipment used to provide care to patients
- Assisted with patient satisfaction
- Preceptor for newly hired employees
- Joint Commission readiness committee
- Participated in LEAN projects in several units of the main campus
Education
High School Diploma -
Thomas Jefferson High School
Masters - Healthcare Administration
CSU
01.2025
Bachelor of Science - Healthcare Administration, Human Services and Behavioral Health
Metropolitan State University of Denver
01.2015
CNA License -
Emily Griffith Opportunity School
01.2005
Skills
- Proficiency in Microsoft Word, Excel, Sharepoint, PowerPoint, EPIC, Life Link, Meditech, Medicomp
- Ability to function individually
- Issue identification and resolution
- Leadership skills
- Time management
- Knowledge in Medicaid and Medicare
- Knowledge in Commercial HMO/PPO coverage
- Commitment to work environment
- Excellent verbal communication skills
- Excellent written communication skills
- Design and Implementation of projects
- Flexibility
- Assertiveness
- Medical terminology proficiency
- Documentation proficiency
- Teamwork
- Customer service
- Reliability
- Critical thinking
Accomplishments
- Supervised team of 15 staff members.
- Collaborated with team of 10 in the development of phone tree project
- Documented and resolved compliance within triage process which led to improved wait time for patients
- Achieved online scheduling and clinic procedures by introducing updated website for patients
Timeline
Disability Examiner
State Of Colorado Department Of Human Services
03.2019 - Current
Referral Coordinator
Denver Health Medical Center
01.2016 - 10.2019
CSS III
Denver Public Health
01.2014 - 01.2016
Internship for Metropolitan State College
Denver Public Health
01.2014 - 01.2015
CNA Float Pool
Denver Health Main Campus
01.2013 - 01.2014
Cardiology Tech (Agency)
Kaiser Permanente
01.2012 - 01.2013
Unit Coordinator/PCT
Saint Joseph Hospital
01.2005 - 01.2012
Masters - Healthcare Administration
CSU
Bachelor of Science - Healthcare Administration, Human Services and Behavioral Health
Metropolitan State University of Denver
CNA License -
Emily Griffith Opportunity School
High School Diploma -
Thomas Jefferson High School
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