Description :

1. Assisted patients, providers, and facilities with pre-authorizations via phone regarding various issues.
2. Contacted members upon hospital discharge for the follow-up to ensure patients received and understood hospital discharge instructions.
3. Researched and updated information as needed using Single Point System.
4. Licensed in a mental health field is required. Willing to consider those individuals nearing licensure.
5. Experienced with assessments and admissions highly preferred.
6. Provided full assessments to individuals presenting to Open Access.
7. Assessed appropriateness/readiness of referrals for counseling and other service lines (such as CPRC and CSTAR).

Experience

2-5 Years

Level

Junior

Education

GED

Description :

1. Assisted patients, providers, and facilities with pre-authorizations via phone regarding various issues.
2. Opened, closed, and updated cases accordingly.
3. Distributed and attached clinical information, assign cases.
4. Contacted facilities or providers as needed.
5. Contacted members upon hospital discharge for the follow-up to ensure patients received and understood hospital discharge instructions.
6. Responsible for identifying any needs or problems upon discharge and resolve accordingly (i.e. problems with medications, home needs, DME, unresolved issues upon discharge, etc.).
7. Referred patients to nurse/ case manager as needed.

Experience

5-7 Years

Level

Junior

Education

MS

Description :

1. Gathered individual and family background information, expressing narrative of individual past issues and challenges, that will assist with clinical approach and preliminary diagnoses.
2. Assisted individuals and families with developing, obtainable and measurable, short-term and long-term, treatment goals using Likert Scale and other measurable treatment tools.
3. Revised Treatment Plan with Individual and families, discussing progress of treatment and assist with planning how to manage and or potentially overcome current treatment challenges.
4. Assigned individual and families to primary Therapist and groups based upon clinical evaluation of individual and or family treatment needs.
5. Provided individual and/ or group therapy to children and adolescent youth assisting with positive decision making, coping with current and past issues, preparation and planning for future goals, and building healthy and positive relationships by exploring instrumental and terminal values.
6. Provided Family Therapy, assisting families with building positive connections and understanding each others needs to achieve long-term healthy positive relationship.
7. Consulted and collaborated with clinical and administrative team, discussing progress and concerns of clients;identify high risk factors to ensure effective implementations of appropriate interventions for individual care.

Experience

5-7 Years

Level

Executive

Education

Master Of Science

Description :

1. Assisted in ensuring TRICARE beneficiaries receive the highest quality specialty health care through processing referrals/authorizations that meet or exceed cycle time and quality standards.
2. Applied subject matter expertise to examine and analyze the referral and authorization process, and the referrals and authorizations processed by others.
3. Provided feedback and guidance to ensure standardization and accuracy in referral management.
4. Developed and submitted reports of audit findings.
5. Functioned in a support, training, or mentoring capacity as requested, and participate in process and performance improvement activities.
6. Processed referrals and authorizations for Tricare Beneficiaries to civilian providers Assisted Military Treatment Facility Coordinators in locating providers Trained new employees Assisted Benefit Service Representative with Tricare Briefing.
7. Complimented the effort given to agency summer youth program and recognizing the positive behavioral difference within the youth, when the summer program transition back to individual and group therapy.

Experience

5-7 Years

Level

Junior

Education

Masters Of Business Administration

Description :

1. Answered phone calls from providers, hospitals, doctors offices and members regarding pre-authorization for inpatient and outpatient procedures.
2. Answered any questions pertaining to coverage and authorizations as well as working faxes and cross training.
3. Worked with different programs to enlighten members and providers on changes as well as gaining more knowledge for myself.
4. Assisted in the global market taking calls from across the United States and working incoming faxes.
5. Used Customer service, all major computer applications as well as many designed specifically for Humana.
6. Knowledged of healthcare is vastly growing which enables my customer service skills to become more important as well.
7. Used Cognitive Behavior Therapy and the usage of the ABC model, to assist with positive decision making; assessing past unwanted outcomes and behaviors, to plan how to avoid potential re-occurrences.

Experience

7-10 Years

Level

Management

Education

GED

Description :

1. Responsible for identifying any needs or problems upon discharge and resolve accordingly (i.e. problems with medications, home needs, DME, unresolved issues upon discharge, etc.).
2. Accurately obtained information to carry out registration and pre-registration of patients.
3. Effectively captured patient demographic and health insurance data for system entry.
4. Worked with members and providers to provide them the perfect health care experience.
5. Provided guidance to our members so they can achieve well-being.
6. Carefully collected information from resources and tools provided to me to determine if cases need further clinical review or if it's something that can be approved at the level.
7. Provided psychotherapy for persons served.

Experience

7-10 Years

Level

Management

Education

Associate's Degree

Description :

1. Received inbound calls to obtain clinical information from providers necessary to create authorizations, referrals, etc.
2. Documented all calls and ensured requests were routed to the appropriate party and attached all clinical information received via fax.
3. Investigated pended cases to ensure that they were processed appropriately and/or routed to the appropriate party.
4. Completed any assigned tasks or special projects by Leadership Mentored new associates Utilized strong problem-solving skills to understand and meet the needs of providers and members.
5. Strong ability to maneuver several systems and applications simultaneously.
6. Updated and maintained provider spreadsheet using Excel.
7. Verified member's benefits, paid through dates, and other policy-related inquiries.

Experience

5-7 Years

Level

Executive

Education

GED

Description :

1. Taken inbound calls from PCP/Specialist/Facilities to input outpatient and inpatient authorizations in system using ICD9 and CPT codes for pending cases or approvals.
2. Reviewed cases for Inpatient Admissions and making determinations if case is Senate Bill, Acute or Future case.
3. Called Primary Care Physician for approval or notification, based on the case.
4. Called Facility to give approval for inpatient admissions.
5. Researched and entered referrals for Commercial/Medicare/Medicaid members using ICD9 and CPT codes for approval.
6. Trained new associates on Medicaid process.
7. Created and mailed denial letters for clinical team.

Experience

10+ Years

Level

Senior

Education

BBA

Description :

1. Assisted clinical intake team with various clerical and administrative tasks as needed.
2. Provided outstanding customer service in a friendly and knowledge manner.
3. Processed notifications, authorizations, referrals, continuities of care, and transfer of care accurately.
4. Updated cases with dates of service, diagnosis or procedure codes, and corrected facility and doctor information.
5. Made outbound calls to providers to obtain information necessary to create or update the authorization.
6. Participated in special projects as assigned by clinical intake leader.
7. Daily used of Microsoft Word, Excel, CCA, CCP2 and other job specific programs.

Experience

2-5 Years

Level

Junior

Education

Bachelors

Description :

1. Assisted Clinical Intake Team with various clerical and administrative tasks as necessary.
2. Processed notifications, authorizations, conversions to observation, and referrals not requiring clinical review.
3. Appropriately routed cases needing clinical follow-up.
4. Ensured members are picked up by internal and external disease management programs in a timely manner.
5. Answered inbound calls and make outbound phone calls to complete the authorization process and communicate status.
6. Participated in special projects as assigned by the Clinical Intake leader.
7. Effectively trained other personnel and managers on the use of the hospital's computer system.

Experience

10+ Years

Level

Senior

Education

MS