Sadie M. Blackwell
Catonsville,MD
Summary
Proactive Clinical Coordinator excited to transition into a new position where superb leadership and clinical coordination abilities can be utilized. Skilled in task delegation, staff recruitment and scheduling. Committed to ensuring staff is compliant with all safety and health standards and protocols.
Overview
23
23
years of professional experience
Work History
Senior Clinical Administrative Coordinator
United Healthcare MD
09.2015 - Current
- Employee & Individual / Genetics Team
- Reviewing Prior Authorizations for Genetic testing prior to RN/MD review
- Verifies and complies benefit language into predesigned templates based on case type and line of business
- Performing verbal notification of case decisions after review to Providers and Members
- Adhering to all state and federal guidelines in relationship to turn around times and notification process
- Responsible for making administrative approvals and denials based on Core Process Guidelines
- Responsible for generations and requesting letters based on case type and Core Process Guidelines
- Reviewing Notification for all provider demographics
- Updating provider
Clinical Administrative Coordinator
United Healthcare MD
03.2008 - 09.2015
- Managing the admission/discharge and bed day information post-notification for UHC Commercial and Medicare members
- Manage the referrals process, create and process incoming and outgoing referrals
- Validate and verify eligibility for all acute inpatient, sub-acute and medical rehab notifications
- Monitor and manage sub-acute Medicare/Medicaid policy holders and hospice cases that do not meet priority review guidelines
- Verify and assess any special account instructions and or medical group information
- Provide administrative coverage determinations and benefit documentation for inpatient requests
- Create appropriate notification and denial letter(s) as required
- Identify cases that meet criteria for inpatient review of covered health services
- Update and correct ICD9 and CPT codes on incoming notifications
- Analyze and audit cases on daily error reports, blended census report and monthly productivity reports
- Identify surgical scheduled cases for possible observation conversion and make outreach to physician to covert to outpatient/ observation conversion
- Build authorizations in HSR systems when needed
- Research and resolve external and internal issues
- Other projects and job duties as assigned i.e., UAT Tester for my business segment for past 3 years
Sr. Operations Coordinator
United Health Care
09.2004 - 03.2008
- Impatient Clinical Care Coordination
- Produce Inpatient Retrospective report 3 times a week
- Track newborn enrollment and create authorizations upon enrollment
- Fax copies of Rockville inpatient census daily to onsite hospitals
- Enter discharges and cut & paste notes, daily for onsite nurses submitted via Lotus Notes and fax server
- Track monthly length of stay from HMR
- Distribute monthly HMR reports to onsite nurses
- Prepare agenda and all handouts for twice monthly onsite meeting
- Track retro numbers monthly
- Order medical records for onsite nurses for retro reviews
- Transcribe clinical reviews from the telephonic review line into documentation template
- Transcribe faxed clinical reviews into the documentation template and send to nurses
- Create homecare authorizations
- Create ambulance authorizations
- Track Optum encounters based on data submitted by onsite nurses
- Maintain the departments PTO calendar
- Email/ Voicemail management (check and responds to all emails and voicemail request in a timely manner
Network Information Coordinator
Mid-Atlantic Medical Services
Rockville, MD
12.2003 - 09.2004
- Responsible for the receipt and assessment of provider changes
- Provided detailed instructions for the Data Entry team to follow
- Worked closely with Provider Relations, Credentialing Coordinators and Practice administrators ensuring all submitted changes were accurate and feasible prior to sending request to the Data Entry Team
Credentialing Coordinator
Mid-Atlantic Medical Services
Rockville, MD
08.2000 - 12.2003
- Responsible for the completion of Credentialing and Re-Credentialing applications
- Maintained copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
- Sets up and maintains provider information in online credentialing databases and systems
- Tracked license and certification expirations for all providers to ensure timely renewals
- Focused on maintaining updated knowledge of health plan, agency and NCQA requirements for Credentialing Doctors and other health care providers
Data-Base Specialist
United Health Care of the Mid, Kelly Services
Atlantic Baltimore, MD
07.1999 - 08.2000
- Responsibilities included accurate and timely loading of new providers
- Maintaining data for new and existing providers including demographics, contract panels and fee schedules
- Other duties I performed included tracking, dispersing, researching and adjudications of claims suspended to department
Education
High School Diploma -
Hazelton Senior High School
Certificate of Completion Medical Terminology - undefined
Catonsville Community College
Certificate of Completion- Computerized Bookkeeping and Office Practices - Catonsville - undefined
Community College
Skills
- Responsible Dedicated Sr Coordinator with over 20 years as a Administrative Coordinator
- Experienced with Commercial insurance and Gated products
- Understands insurance benefits and coverage criteria following both state and federal guidelines
- Adept at deciphering Certificate of Coverage and Summary Plan Descriptions in preparation for clinical review
- Excellent customer skills multiple years of communicating with both internal and external customers
- Comfortable working in multiple applications simultaneous
- Adept at tracking progress and assignments using Microsoft office suite
- Consistently meet quality and turnaround times for over 20 prior authorizations daily
- Health Information Systems (HIS)
- Medicare Compliance
- Patient Health Information Access
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Timeline
Senior Clinical Administrative Coordinator
United Healthcare MD
09.2015 - Current
Clinical Administrative Coordinator
United Healthcare MD
03.2008 - 09.2015
Sr. Operations Coordinator
United Health Care
09.2004 - 03.2008
Network Information Coordinator
Mid-Atlantic Medical Services
12.2003 - 09.2004
Credentialing Coordinator
Mid-Atlantic Medical Services
08.2000 - 12.2003
Data-Base Specialist
United Health Care of the Mid, Kelly Services
07.1999 - 08.2000
High School Diploma -
Hazelton Senior High School
Certificate of Completion Medical Terminology - undefined
Catonsville Community College
Certificate of Completion- Computerized Bookkeeping and Office Practices - Catonsville - undefined
Community College
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