Hi, I’m
Stephanie A. Wilson
Fairfield,CA
Summary
Self-motivated professional promoting attention to detail and the drive to resolve issues effectively. Calm and poised in the most stressful environments. Seeking the opportunity to join new organization in the role of Healthcare professional.
Overview
21
years of professional experience
Work History
Brown & Toland/AltaisOakland, CA
Inpatient Utilization Management Coordinator
12.2019 - Current
Job overview
- Coordinates and implements the transition of care (TOC)/Discharge plan for acute care
- Responsible for obtaining and accurately entering data for Inpatient authorizations, discharges, eligibility benefit checks and Care Management referrals into the Altais/Brown and Toland Systems to track programmatic and member activity
- Provide census coordination, gather information from the hospitals or other tertiary facilities to inform the care management team, providers, researchers, and leadership detailed clinical data elements to use when assessing a member
- Responsible for assisting with the development, coordination, and delivery of necessary member notice of non-coverage letters, member reinstatement letters, facility denial letters, facility reinstatement letters and any other appeals
- Communicates regularly with contracted Health Plans, Behavioral Health organizations, Brown & Toland medical director, and care management team and any other provider when appropriate, e.g., readmitted members, California children’s services or health plan audits
- Responsible for scheduling, confirming patient appointments post discharge and escalating issues to the clinical team
- Responsible for screening for care management programs
- Provides administrative support to the Care Management team such as accurately entering authorizations for home health, Durable Medical Equipment, social services identification, and member targeted mailings
- Coordinates with other departments like Referral Services, Health Care Analytics, Claims, Quality Management activities
- Responsible for all incoming care management related questions
- Supports East Bay and West pilot program to engage and connect members with services post discharge
- Warm transfer calls to Social Workers who reach out to members to follow-up after coordination of outpatient care
- Respond to provider, member, and staff inquiries at any given time in a professional and timely manner.
California Pacific Medical CenterConcord, CA
Patient Care Coordinator/Scheduler/Registration
10.2013 - 11.2019
Job overview
- Supports the clinical operations of the Outpatient departments and provides seamless appointment scheduling and registration to patients and referring physicians across Sutter Health Affiliates by aligning scheduling guidelines with patient appointment preferences
- Consistently facilitates positive multi-channel communications among patients, physicians, clinical staff, and internal departments using advanced writing, telephone and e-mail and internet skills
- Coordinating patient needs and securing financial clearance by validating eligibility and verification of insurance coverage and obtaining authorization
- Maintaining a high volume of contact with patients, clinical staff, and management daily
- Collecting and entering sensitive information into a computerized medical records system
- Validating referrals for speech, occupational, and physical therapy for processing
- Completing patient registration, verifying health plan benefits, and collecting co-payments
- Assisting with development and implementation of department improvements and standardized workflow
- Responsible for training new employees on standardized department operations
- Crossed trained to assist in orders management, and breast health scheduling when staffing needs occur
- Organized and lead study focused group to obtain national certification as healthcare access associate.
Commerce West InsurancePleasanton, CA
Customer Service Representative
12.2010 - 07.2012
Job overview
- Provided information regarding automobile and homeowner policies to policy holders requesting billing information regarding deductible amounts, premium increases, and coverage amounts on vehicles and homes
- Responsible for endorsing policies to reflect changes in addresses, removing and adding vehicles, and reinstating cancelled policies
- Determined policy errors, and submitted request for corrections to accounting department for refunds on polices overpaid by insured or charged incorrectly
- Received and cancelled premium payments via Western Union Speed-pay.
Comcast Cable CommunicationsLivermore, CA
Advanced Services Representative
05.2008 - 02.2010
Job overview
- Provided first call resolution to customer’s phone inquiries regarding services, troubleshooting, programming conflicts, and managed client information
- Fielded inbound calls in a high-volume call center environment
- Utilizing a variety of software applications to administer customer account information
- Diagnosed and resolved technical difficulties
- Selling and up-selling Comcast products and services based on logical relationship to the customer’s needs
- Provided inbound telephone support via a proprietary computer system to customers experiencing technical difficulties and equipment problems to reduce service calls and improve customer satisfaction
- Responded to billing inquires, resolving service concerns provided rate and programming information
- Researched misapplied payments, billing, and service adjustments.
Children’s Hospital & Research CenterOakland, CA
Claims Examiner
06.2006 - 09.2007
Job overview
- Under supervision, billed all in- and out-patients covered by Medicare, Medicaid, Blue Cross, managed care, commercial insurance companies, and other third-party payers
- Acted as a liaison between patients, third party payers, physicians, clinics, departments, and the Medical Center regarding billing
- Participated in quality assessment and continuous quality improvement activities
- Complied with all appropriate safety and infection control standards
- Performed all job duties and responsibilities in a courteous and customer-focused manner according to Children’s Hospital standards of behavior
- Processed all types of claims including but not limited to PCP
- Preparing weekly claims status reports of claims processed and inventory on hand
- Maintained acceptable quality with a maximum of 3% error ratio
- Processed 300 routine claims daily of moderate and complexity.
Alameda Alliance for HealthAlameda, CA
Claims Examiner
12.2002 - 06.2006
Job overview
- Processed all types of claims including but not limited to PCP
- Preparing weekly claims status reports of claims processed and inventory on hand
- Maintained acceptable quality with a maximum of 3% error ratio
- Processed 300 routine claims daily of moderate and complexity
- Reviewing and analyzing claims for resolution and routing to appropriate departments
- Produced reports and internal advising.
Education
CHAA- Certified Healthcare Access Associate Certified
04.2017
Berkeley City College
Associates of Arts degree from Liberal Arts
01.2008
AltaisAltaisBryman College
Medical/Billing Coding Certificate
01.2002
Cal State University
B.A Degree from Human Development
Skills
- TECHNICAL SKILLS
- MICROSOFT/WORD/EXCELL/ACCESS POWERPOINT
- Interpersonal and Written Communication
- Documentation and Reporting
- Utilization Review
- Patient Care Plans
- Records Analysis
- Patient Advocacy
- Regulatory Requirements
- HIPAA Guidelines
- Admitting and Discharging
- Problem Identification
- Patient Care Assessment
- Critical Thinking
- Multidisciplinary Team Collaboration
- Hospital Coordination
- Verbal and Written Communication
- Epic Systems
- Risk Management
- Patient Relations
- Schedule Management
- Training and Mentoring
- Performance Metrics
Timeline
Inpatient Utilization Management Coordinator
Brown & Toland/Altais
12.2019 - Current
Patient Care Coordinator/Scheduler/Registration
California Pacific Medical Center
10.2013 - 11.2019
Customer Service Representative
Commerce West Insurance
12.2010 - 07.2012
Advanced Services Representative
Comcast Cable Communications
05.2008 - 02.2010
Claims Examiner
Children’s Hospital & Research Center
06.2006 - 09.2007
Claims Examiner
Alameda Alliance for Health
12.2002 - 06.2006
CHAA- Certified Healthcare Access Associate Certified
Berkeley City College
Associates of Arts degree from Liberal Arts
AltaisAltaisBryman College
Medical/Billing Coding Certificate
Cal State University
B.A Degree from Human Development
Similar Profiles
D'LATISHA BROOKSD'LATISHA BROOKS
Community Outreach Coordinator at Altais Health SolutionsCommunity Outreach Coordinator at Altais Health Solutions
Stacey R. GainesStacey R. Gaines
Sr. RCM & Ambulatory Informatics Advisor at AltaisSr. RCM & Ambulatory Informatics Advisor at Altais
Estefania QuirozEstefania Quiroz
Medical Assistant at Altais - Family Care SpecialistMedical Assistant at Altais - Family Care Specialist
Jerry RojoJerry Rojo
Care Assistant at Private DutyCare Assistant at Private Duty
Jason HernandezJason Hernandez
Special Event Bartender at Solano Yacht ClubSpecial Event Bartender at Solano Yacht Club