Tammy LeClaire
Colton,CA
Summary
Highly organized and detail-oriented professional with strong work ethic and dedication to achieving goals. Skilled at developing and maintaining documentation systems, managing calendars and preparing reports. Knowledgeable in project management principles, business processes and customer service best practices.
Overview
26
26
years of professional experience
Work History
Case Manager Assistant
Loma Linda University Medical Center
12.2008 - Current
- Assist Case managers with discharge needs to include skilled nursing facilities, Acute Inpatient Rehab, DME, Home Health, make all POST discharge hospital follow up appointments.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Monitor all IEHP high risk for re-admissions and IEHP CHF patients for transitional care needs.
- Clinically review and justify all Medi-cal patients for all the Main Campus, East Campus and Surgical Hospital.
- Able to verify all insurance payers (Medi-cal, Medicare, IEHP, Molina, commercial insurance, HMO insurance, etc)
- Able to request insurance authorizations
Lead Coordinator- Mt View Pharmacy
Loma Linda University Medical Center
05.2005 - 12.2008
- Managed multiple projects simultaneously, ensuring timely completion and high-quality results.
- Resolved conflicts within the team effectively, maintaining a positive working environment conducive to high-quality work output.
- Took incoming referrals and pre-qualified patients.
- Verify insurance coverage and obtain authorization.
- Register patient information, coordinate the dissemination of incoming and outgoing information between patient and referral source.
- Prepare TARs (Treatment authorization request) for authorization
- Worked closely with hospital case managers to ensure quality care upon discharge
- performs pharmacy technician duties as requested
Case Manager Assistant-Loma Linda Home Health
Loma University Medical Center
11.2001 - 05.2005
- Maintained all TARs for HHA, ST, PT, OT and RN
- Transcribed all OASIS assessments to prepare them to transmit to the state for Medicare payment
- Transmittals of all OASIS assessments to the state weekly
Compounding Pharmacy Technician
Loma Linda University Medical Center
11.1998 - 11.2001
- Optimized inventory management, reducing waste and ensuring availability of necessary supplies.
- Supported pharmacy team by efficiently organizing supplies, cleaning workspaces, and assisting with daily operations as needed.
- Conducted quality control tests on compounded medications, ensuring safety and efficacy for patients.
- Collaborated with pharmacists to provide high-quality patient care and tailored medications.
- Maintained a high level of understanding of drug industry reimbursement
Billing Specialist
Loma Linda University Medical Center
03.1998 - 11.1998
- Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
- Researched and resolved billing discrepancies to enable accurate billing.
- Provided excellent customer service, developing and maintaining client relationships.
- Monitored customer accounts to identify and rectify billing issues.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
Education
High School Diploma -
Bloomington High School
Bloomington, CA06.1991
Skills
- Problem-Solving
- Case Management
- Case Documentation
- Organization and Multitasking
- Positive Attitude
- Care Coordination
- Records Management
- Referral Coordination
- Case Management Tracking
- Discharge Planning
- Utilization review
- EMR / EHR
Timeline
Case Manager Assistant
Loma Linda University Medical Center
12.2008 - Current
Lead Coordinator- Mt View Pharmacy
Loma Linda University Medical Center
05.2005 - 12.2008
Case Manager Assistant-Loma Linda Home Health
Loma University Medical Center
11.2001 - 05.2005
Compounding Pharmacy Technician
Loma Linda University Medical Center
11.1998 - 11.2001
Billing Specialist
Loma Linda University Medical Center
03.1998 - 11.1998
High School Diploma -
Bloomington High School
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