Stacie Evans
San Diego,CA
Overview
15
15
years of professional experience
Work History
Customer Service Representative
Rady Children's Hospital
09.2018 - 01.2019
- I am the first line of contact for CalOptima members and providers
- Assist members and providers with questions related to the Medi-Cal programs for Orange County
- Resolves member inquiries and complaints fairly and effectively
- Verify member eligibility, claim and authorization status for providers
- Responsible for thorough follow-up and completion of all member, and provider inquires or requests
- Responsible for accurate, complete and correct documentation into Facets regarding all issues, and/or inquires, complaints and grievances
- Function efficiently and productively in a high-volume telephone call center
- Maintain departmental productivity and quality standards
- Provide follow-up assistance as needed
- Route escalated calls to the appropriate Member Liaison, Supervisor or Call Center Manager
- Refer issues to health networks and/or make recommendations for further contacts within CalOptima
- If designated, responsible for processing all member transportation request within 1 business day of receipt and coordinating all aspects of the process with clinic, provider and member as appropriate or necessary
- Adhere to company and departmental policies and procedures
- Assists Members with CalOptima's Member Web Portal registration and technical support
- Other duties or projects as assigned by management
- Provide assistance with claims for all providers contracted with Cal Optima In an accurate and understandable way adhering to all Policies
Service Order Planner
SDGE
01.2019 - Current
Surgical Coordinator/Medical Assistant
cCARE
04.2018 - 11.2018
- Coordination of Care for 3 locations
- Authorizations and Approvals
- Take care of multi phone line
- Scheduling of all patients
- Adherence to all procedures
Surgical Coordinator/Practice Manager
Neurosurgical Medical Clinic
12.2017 - 03.2018
- Manage patient check-in and check-out process from start to finish with up to 40 patients per clinic
- Handle multi-phone line receiving 80-100 calls on a daily basis
- Coordinating Care of all surgical patients to include: Home health, caregiving, Ombudsman Identification and insurance verification, updating or confirming demographic
- Ensuring appropriate forms are provided, signed and witnessed at the time of the patient visit
- Verify coverage including benefits, authorization, predetermination, payer specific policy exclusions or limitations to coverage
- Collect any patient responsibility and accurately prepare end of day reporting or payment reconciliation
- Entering appropriate insurance, initiating and completing all authorizations and referrals
- Utilization management, billing and coding
- Maintaining Outlook Calendar for the office and physicians
- Maintain control of 3000 patient database using various EMR Systems
- Ability to place all orders from the physician into patients charts, as well as medications needed for the patients
- Working closely with all out of network insurances, to include Letter of Agreements
- Gathering of all pertinent medical information allowing patient approval as expeditiously as possible
Surgical Coordinator
Scripps Clinic Torrey Pines
08.2009 - 10.2017
- Implemented tracking system to maintain effective care for our patients
- Mentored and trained upwards of 20 staff on departmental procedures
- Capability of independently generating data, and documenting work
- Successfully exhibited proficiency in the scheduling procedures, scheduling and confirming appointments according to practice guidelines
- Entered appropriate insurance, initiated authorizations and referrals
- Scheduling all Ancillary
- Responsible for interacting with patients, payers and providers to gather information necessary for accurate registration
- Include assigning of appropriate Medical Record Number, scheduling, referrals, prior authorization, point of service payment collection, and documentation of collection and arrival
Education
GED -
Concord University
San Diego, CAAssociate in Theology -
Ephraim Life Seminary College
Skills
- SCHEDULING
- BILLING
- CUSTOMER SERVICE
- CPT
- EMR
- Medical Records
- Outlook
- Microsoft Office
- Epic
- MS Office
- Filing
- ICD-10
- Insurance Verification
- Allscripts
- EClinicalWorks
Personal Information
Title: Surgical Coordinator/Practice Manager
Assessments
- Electronic Health Records: Best Practices, 09/01/20, Highly Proficient
- Verbal Communication, 09/01/20, Expert
Timeline
Service Order Planner
SDGE
01.2019 - Current
Customer Service Representative
Rady Children's Hospital
09.2018 - 01.2019
Surgical Coordinator/Medical Assistant
cCARE
04.2018 - 11.2018
Surgical Coordinator/Practice Manager
Neurosurgical Medical Clinic
12.2017 - 03.2018
Surgical Coordinator
Scripps Clinic Torrey Pines
08.2009 - 10.2017
GED -
Concord University
Associate in Theology -
Ephraim Life Seminary College
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