Secenia Medina

• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Performed prior authorization review of services requiring notification.
• Performed admission reviews based for medical necessity based upon level of care required.
• Obtained authorizations from multiple insurance carriers for various levels of care.
• Supervised and maintained all utilization review documentation through Decision Point.
• Submitted cases to Clinical Nurses/Insurance for criteria failures and helped facilitate resolutions and approvals.
• Devise or identify solutions for irregular requests and issues.
• Served as subject matter resource, providing information related to DC Planning needs of all patients.
• Facilitated workgroup meetings with Administration/Physicians/Clinical staff/and patients to find effective solutions to issues.
• Supported or performed clinical appeals will all insurance companies [Action]. on any level of patient care.
• Trained all staff, providing ongoing staff development and continuing education to employees.
• Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
• Communicated with patients, ensuring that medical information was kept private.
• Fostered excellence by example by "setting pace" and being hands on mentor to clinical staff.
• Created customized care plans, working with hospital staff and families to assess and meet individual needs.
• Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
• Organized and facilitated multiple department head meetings weekly, discussing current census, admissions and discharges and residents' Medicaid applications.
• Defined testing protocols, quality assurance initiatives and clinic policies and procedures.
• Implemented best practice standards for billing resulting in substantial reduction of accounts receivable delays.
• Increased patient satisfaction scores by the percentage requested for our department, within ti,e frame given.

same as Oasis hospital