Summary
Overview
Work History
Education
Skills
Timeline
Generic

Stacey Plescia

Madisonville,LA

Summary

Accomplished Utilization Review Specialist with a proven track record at Healthcomp, enhancing care through meticulous utilization review and interdepartmental collaboration. Expert in HIPAA compliance and healthcare regulations, with a flair for problem-solving and team collaboration. Achieved significant improvements in patient resource connectivity and care plan development, demonstrating a compassionate approach and analytical prowess.

Reliable individual bringing 14 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress.

Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.

Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level coding position. Ready to help team achieve company goals.

Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.

Overview

12
12
years of professional experience

Work History

Utilization Review Specialist

Healthcomp
03.2015 - Current
  • Proactively addressed potential barriers to care during the review process, connecting patients with appropriate resources such as financial assistance programs or support groups.
  • Improved interdepartmental communication by collaborating with medical professionals, case managers, and social workers to develop comprehensive care plans.
  • Demonstrated strong analytical skills by interpreting complex medical records and synthesizing relevant information for utilization review purposes.
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Supervised and maintained all utilization review documentation through Software.
  • Maintained strict confidentiality of patient information, adhering to HIPAA regulations and organizational policies regarding privacy and data security.

Scheduling Coordinator

Dr. Elizabeth White
02.2013 - 03.2015
  • Proactively identified scheduling issues and developed quick solutions to promote efficiency and profitability.
  • Utilized advanced software tools like Excel, Outlook, and scheduling-specific platforms to effectively manage comprehensive appointment calendars.
  • Optimized workflow by prioritizing tasks based on urgency and aligning staff assignments accordingly.
  • Oversaw appointment scheduling and itinerary coordination for both clients and personnel.
  • Developed strong working relationships with management and executive team through effective scheduling and communication skills.
  • Maintained accurate records of employee time off requests, facilitating fair distribution of vacation days among staff members.

Education

High School Diploma - General Studies

Manchester High School
Manchester, NH

Skills

  • HIPAA compliance
  • Quality improvement
  • Healthcare regulations
  • Medicare compliance
  • Milliman care guidelines
  • Medical necessity criteria
  • Insurance verification
  • Documentation and reporting
  • Interpersonal and written communication
  • Utilization review
  • Medical coding
  • Teamwork
  • Problem-solving abilities
  • Multitasking
  • Compassionate and caring
  • Reliability
  • Active listening
  • Team collaboration

Timeline

Utilization Review Specialist

Healthcomp
03.2015 - Current

Scheduling Coordinator

Dr. Elizabeth White
02.2013 - 03.2015

High School Diploma - General Studies

Manchester High School
Stacey Plescia