Stephen Jones
Lexington,SC
Summary
Seeking and maintaining a challenging opportunity providing direct or indirect quality service delivery for patients and their families. Current position of Psychiatric Access Reviewer working within realm of Intake & Triage Department and Utilization Review. Strong track record of establishing solid relationships with all persons engaged in patient care. Dynamic and dedicated healthcare worker with 39 years experience: 9 years in medical administration followed by 30 years in behavioral health. Experience as Addictions Counselor and Clinical Intake & Triage Counselor/Coordinator.
Overview
18
18
years of professional experience
1
1
Certificate
Work History
Access Service Reviewer
Three Rivers Behavioral Health Hospital
West Columbia, SC
07.2018 - Current
- Collaborate and coordinate with designated staff to get pertinent information for inpatient precertification.
- Maintain system for tracking progress from time case obtained in Needs Assessment & Referral Center until days are secured.
- Maintains documentation in MS4 and Midas System on progress of each case still in precertification standing notifying Director of Needs Assessment and UR staff of problems/denials at time of occurrence.
- Ensure verification of insurance on all cases.
- Assist Director of Needs Assessment in education of staff related to precertification.
- Maintain up to date detail list of insurance companies, along with how to verify and obtain precertification for each.
- Demonstrate understanding of legal considerations relative to: patient's rights, involuntary commitments, COBRA/EMTALA and confidentiality.
- Manages time and work load efficiently while demonstrating self-motivation.
- Assist in training of new employees as assigned.
- Consistently provides quality work, with little supervision.
Access Service Reviewer
Augusta University Medical Center
Augusta, GA
01.2014 - 06.2018
- Collaborated and coordinated with physician and designated staff to get pertinent information for inpatient acute psychiatric precertification and concurrent certification. Conducted and tracked concurrent reviews and appeals for 29 bed inpatient psychiatric unit within medical center.
- Maintained current knowledge of all third party payers as well as assigned behavioral health managed care review company. Review medical records and make recommendations to physicians for clinical documentation improvement.
- Provided consultation to physicians, residents. and staff related to precertification, authorization and documentation process.
- Expedites with treatment team alternatives when precertification or hospital admissions are denied by payer.
- Developed and maintained policy and procedures manual for Access Service Reviewer protocol.
- Demonstrated good interpersonal skills, consistently interacted positively with patients, families, staff and third party payers while working in fast paced and high stress environment.
- Proved ability to work independently on consistent basis.
Clinical Intake Coordinator
Medical College Of GA /Augusta Univ Medical Center
Augusta, GA
08.2004 - 01.2014
- Provided timely assessments (10+ daily) and responding to pages (15+ daily) in timely manner
- Communicated patient's conditions and dispositions to all involved staff in effort to maintain "team" approach.
- Exhibited sound clinical judgement as evidenced by documentation on Intake & Triage screening form and Utilization Review form.
- Completed precertification and utilization review assignments as expected.
Education
Bachelor of Science - Social Work
Appalachian State University
Boone, NC1990
Skills
- Superior communication skills and positive interaction experience with patients, family members, as well as intra and inter-departmental colleagues
- Demonstrated ability to establish, foster and maintain positive interactions with third party payers emphasizing mutual respect and trustworthy relationships
- Clinical documentation mastery
- Expert with medical necessity criteria for initial and concurrent review for behavioral health admissions
- Detail oriented Self-motivated Works well independently or with team
Certification
- Licensed Bachelor of Social Work - LBSW South Carolina.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Quote
In times like these, it helps to recall that there have always been times like these.
Paul Harvey
Timeline
Access Service Reviewer
Three Rivers Behavioral Health Hospital
07.2018 - Current
Access Service Reviewer
Augusta University Medical Center
01.2014 - 06.2018
Clinical Intake Coordinator
Medical College Of GA /Augusta Univ Medical Center
08.2004 - 01.2014
Bachelor of Science - Social Work
Appalachian State University
Similar Profiles
JAMES ANDERSONJAMES ANDERSON
Care Coordinator/Certified Peer Support Specialist at Highland Rivers Behavioral Health (Military Veteran Services)Care Coordinator/Certified Peer Support Specialist at Highland Rivers Behavioral Health (Military Veteran Services)
Brandon YorkBrandon York
SOS Caseworker at Four Rivers Behavioral HealthSOS Caseworker at Four Rivers Behavioral Health
Seairra Hinton-UmogbaiSeairra Hinton-Umogbai
Case Manager at Indian Rivers Behavioral HealthCase Manager at Indian Rivers Behavioral Health
Cuyler HawkesCuyler Hawkes
Front of House Staff Member at Chick-fil-AFront of House Staff Member at Chick-fil-A
Bethany Martin-GenaweseBethany Martin-Genawese
National Account Supervisor at EE WardNational Account Supervisor at EE Ward