Review Coordinator Resume Sample

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Shana Flatley
31952 Flavie Garden,  Houston, TX
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Work Experience


Principal Review Coordinator
12/2016 - PRESENT
Detroit, MI
  • Collation and interpretation of product related information into a report format
  • The extraction of data from a number of source systems
  • Collation and analysis of data using statistical analysis tools
  • Liaising with Data Management team to identify data and secure final data analyses
  • Leading review meetings and communicating the output to a cross-matrix team
  • Identifies clinical, financial and psychosocial needs of patients/families and provides leadership and guidance to the multidisciplinary team to develop an individualized plan of care
  • Coordinates appeals when NC Medicaid cases are denied with the DHS Hearing Officer
Utilization Review Coordinator
10/2012 - 06/2016
Boston, MA
  • Ensures that essential information and necessary forms are forwarded to the Medical Audit and Appeals Department of CHS
  • Performs admission and concurrent reviews
  • Applies clinical guidelines during Admission and Concurrent reviews and identifies potential third party denials. Works with multidisciplinary team to identify and implement alternative plans of care
  • Refers pertinent information to the Medical Director, and/or Service Director in a timely manner
  • Collaborates on a daily basis with the physician to plan and implement the medical and multidisciplinary plan of care, utilizing clinical pathways when appropriate and available
  • Works with team members and CMC-R administration to identify problem areas and implement resolutions
  • Develops and maintains accurate case records of assigned cases. Documents in the patient's medical record according to department and facility standards
Quality Review Coordinator
08/2007 - 05/2012
New York, NY
  • Proactively develops plans to accurately measure documentation of services delivered to assure compliance with auditors
  • Oversees service delivery authorizations and assurances, recommends service delivery utilization parameters, and provides quality assurance of service delivery records
  • Provides ongoing technical assistance to clinical staff in the service areas of; facilitation of timely and appropriate service authorization, effective monitoring strategies and report analysis of actual service deliveries in comparison to authorized service approvals (type, units, dollars, etc)
  • Analyzes the over/under delivery of services, and consistent coordination of required service documentation along with corresponding billing tickets. Maintains organized and complete records and assures quality focused service delivery method strategies
  • Completes weekly, bi-weekly, and monthly reviews of all service delivery documentation and corresponding billing ticket/pre invoice submitted by program staff for processing; verifies completeness of required information
  • Responsible for establishing and monitoring the regional office and storage filing systems to assure information is organized, complete, and retrievable for compliance audit file reviews
  • Maintain authorization/certification numbers in Midas
  • Set next review date for UR nurse

Education


Whitworth University
2002 - 2006
School's Degree in Engineering

Professional Skills


  • Effective comprehensive reading skills, strong communication skills, written and verbal
  • Technical Skills: Excellent personal computer skills (MS Outlook, MS Office, Midas, Meditech, OnBase DOS based and other related software)
  • Interpersonal skills and time management skills
  • · Organization skills – able to proactively prioritize needs and effectively manage time
  • Organization skills – able to proactively prioritize needs and effectively manage time
  • Excellent interpersonal skills and ability to work on a team
  • Strong computer skills and able to employ data oriented software (i.e. Excel)

How to write Review Coordinator Resume

Review Coordinator role is responsible for insurance, computer, clinical, basic, software, database, organization, health, training, finance.
To write great resume for review coordinator job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Review Coordinator Resume

The section contact information is important in your review coordinator resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Review Coordinator Resume

The section work experience is an essential part of your review coordinator resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous review coordinator responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular review coordinator position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Review Coordinator resume experience can include:

  • + Good data analysis and comprehension skills. Ability to capture and graph key production data, demonstrates trends, and present key findings and next actions
  • + Proven experience with process measurement and optimization, and managing multiple (and competing) priorities and deadlines
  • · Excellent communication skills with Insurance Plans, UR nurses, and facilities
  • Demonstrated experience working as a psychiatric nurse in a state facility
  • Demonstrated ability participating in survey preparation and maintenance of document requests and credible evidence books
  • Demonstrated experience developing various reports

Education on a Review Coordinator Resume

Make sure to make education a priority on your review coordinator resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your review coordinator experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Review Coordinator Resume

When listing skills on your review coordinator resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical review coordinator skills:

  • Excellent communication skills with Insurance Plans, UR nurses, and facilities
  • Demonstrated experience in addressing quality of care issues, documentation and treatment planning issues as highlighted during audits, unit rounds, etc
  • Prior direct experience in a behavioral health setting
  • Strong preference for candidates with UR experience
  • Experience working with quality systems and procedures in manufacturing
  • Experience working with quality methods and procedures in manufacturing

List of Typical Experience For a Review Coordinator Resume

1

Experience For Utilization Review Coordinator Resume

  • + Experience building and working with external teams in multiple locations
  • + Provide excellent customer service; assist Contributor Success & Compliance teams to swiftly resolve contributor issues and inquiries
  • + Strong command of English; ability to read/write and participate in business operations
  • Builds and maintains strong relationships with members of the finance team and the business partners that we support
  • Knowledgeable & experienced in Quality Measurement or Quality Improvement activities in an acute care hospital
2

Experience For Architectural Review Coordinator Resume

  • Frequently utilize physical ability for standing or sitting for long periods of time
  • Participates in activities that enhance professional development including conferences and continuing education programs
  • Monitor OR/Cath lab schedules for missing authorization/certification numbers and report to UR nurses any deficiencies
  • Able to bend body downward and forward by bending spine at the waist; bend legs at knee to come to a rest on knee(s)
  • + Knowledge of stock images industry and licensing terms
3

Experience For Quality Review Coordinator Resume

  • Ensure that all records are accurate, up-to-date, and in compliance with licensing and legal/corporate requirements
  • Supports the Loan Originations Team by using the Loan Originations systems to process, fund, evaluate, underwrite, etc. loans, as needed
  • · Conducts Service Authorization reviews and receives confirmation from program supervisor(s) for approval of all pending and final service authorizations
  • Provided discharge dates to Plans
  • Monitor fax, phone and email and communicate to UR nurses
  • Monitor authorization / certification report
  • Scan clinical information to Insurance Plans
  • Maintain notes in Artiva as needed
  • Communicate with facilities as needed
4

Experience For Concurrent Review Coordinator Resume

  • Assist UR nurse staff with concurrent denials
  • Monitor and trend reports as needed
  • Able to ascend/descend stairs and ramps; body agility is emphasized
  • Able to extend hands and arms in any direction
  • Able to use upper and lower extremities to exert force in a pulling or pushing motion. Exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects
  • Able to raise objects from a lower to higher position or from side-to-side
  • The worker is subject to both environmental conditions: Activities occur inside and outside
  • The worker is subject to hazards: Includes a variety of physical conditions
  • + Drive the efficient resolution of images escalated by reviewers
5

Experience For Retrospective Review Coordinator Resume

  • + Coordinate review and quality evaluation processes to meet content requirements, achieve production goals and meet time-sensitive content management objectives
  • + Assist with the development of production metrics for content review and quality; establish and align reviewers against throughput expectations
  • + Assist with reviewer recruiting, training and education; participate in the design and implementation of review standards and style guides, online training materials and modules to bring about expedited reviewer onboarding and review consistency
  • + Excellent communicator, decisive, results-driven, people-oriented person with patient training skills along with the ability to motivate teams and resolve time-critical issues
  • + Advanced knowledge of Excel, including pivot tables, formulas, and graphs
  • + Software: Photoshop, Google Applications
  • Learn Trade product structures through participation in Trade's Deal Review process
  • Gain intimate knowledge of ICG Risk Policies and Trade Product programs
  • Introduction to Risk and Legal analysis of Trade Structures
6

Experience For Principal Review Coordinator Resume

  • Monitors for and accepts telephone, fax and electronic requests for clinical information and refers to the most appropriate group or individual in a timely manner
  • Responsible for accurate and timely entry of information related to coordination of reviews into the appropriate information system
  • Maintains data systems and files in an organized manner to allow access of information by appropriate individuals
  • Communicates authorizations to Utilization Review Nurses and documents them in the EMR to avoid potential denials
  • Documents distribution of clinical reviews to third party payers
  • Works collaboratively with Patient Access Staff and Insurance Verification Staff to assure the accurate payer and demographic information is documented in the I.T. systems to promote timely and appropriate billing and payment
  • Work collaboratively with Business Office staff in assuring timely billing of accounts and reconciling open accounts through monitoring status of cases requiring clinical information
  • Effectively use MS Word, Excel and Outlook require
7

Experience For Document Review Coordinator Resume

  • Performs clinical reviews over the telephone. Reviews that entire chart to evaluate the appropriateness of admission, continued stay, discharge criteria and identifies high-risk cases.
  • Facilitates discharge planning with treatment team and coordinates continuum of care for the patient with Social Worker. Monitors the effectiveness of patient outcomes
  • Attends treatment team meetings and serves as a liaison and patient advocate between insurance companies and the treatment team
  • Notifies and alerts Director of UR of potential utilization review problems or denials assists in the preparation and implementation of the appeals process
  • Monitors documentation in clinical records and reports problematic areas to appropriate supervisor, Director of UR
  • Subject to criminal background check and pre-employment drug screen
  • Faxes clinical data to foster care agencies to facilitate hands off communication a mpa mpa mpa mpn bsp
  • · Maintain authorization/certification numbers in Midas
  • · Set next review date on Worklist for UR nurse
8

Experience For Plans Review Coordinator Resume

  • · Provided discharge dates to Plans
  • · Monitor fax, phone and email. Communicate follow-up information to UR nurses
  • · Monitor authorization/certification report
  • · Maintain notes in Artiva as needed
  • · Communicate with facilities as needed
  • · Assist UR nurse staff with concurrent denials as needed
  • · Monitor and trend reports as needed the Far West Division Centralized UR Department in-scope insurance plans
9

Experience For Risk Quality Review Coordinator Resume

  • Provide administrative support to program supervisors and directors
  • Complete and review on-going required documentation for individuals receiving services, such as Individual Program Plans, Plan of Cares, Informed Consents, Activity Schedules, etc
  • Communicate with Direct Support Professionals, Program Coordinators and/or Program Directors if documentation is incomplete or unsatisfactory
  • Ensure that steps are taken to get documentation corrected
  • Knowledge of commonly used concepts, practices and procedures within the field
10

Experience For Bill Review Coordinator Resume

  • Function as Utilization Review Coordinator for Valley Ridge CIT and Glenwood SOICF, specifics to be discussed at interview
  • Develop and maintain data collection systems
  • Prepare for Independent Utilization Review surveys
  • Writes timely and accurate Treatment Authorization Requests (TAR), including requests for extension of stay in hospital and retroactive MediCal extensions. Ensures that TAR includes all necessary information, including a signed admission order by the admitting physician
  • Coordinates admissions and concurrent reviews of MediCal patients. Applies utilization review criteria to determine appropriate level of care and length of stay. Ensures utilization review is completed and documented concurrently, and provided to patient’s payer as required
  • Acts as an effective liaison to medical staff to ensure continuity of care in accordance with the patients plan of care. Refers both admission and continued stays, where criteria have not been met to physician advisor. Maintains liaison with the Medical Staff, Admitting, Business Office, Medical Records, Nursing and Administration
  • Acts as a resource and provides support to coordinator staff in obtaining authorizations to facilitate patient care
  • Acts as a resource to staff regarding third party payor regulations and processes as they relate to coverage and reimbursement

List of Typical Skills For a Review Coordinator Resume

1

Skills For Utilization Review Coordinator Resume

  • Good listening, and oral and written communications skills required
  • Willingness to learn and team building skills required
  • Experience in developing and coordinating an organized approach and system for utilization review and management
  • Experience with Medi-cal and/or Department of Mental Health billing and funding
  • Demonstrated ability to provide training and coaching as needed relevant to documentation, outcomes, and audit findings
  • + Coordinate and liaise with reviewers on a frequent and ongoing basis; providing guidance on priorities, best practices and quality issue resolution support
  • Experience working in a Hospital, Physician’s Office, or Clinic environment
  • One year experience working with Title XIX Waiver program rules, regulations, and limitations
  • Clinical experience in an acute adult medical/surgical care setting -or-
2

Skills For Architectural Review Coordinator Resume

  • Experience with medical billing, insurance and patient contact
  • Experience with Microsoft Office software including Word and Excel
  • Valid driver's license and driving record that meets insurance requirements
  • Confirm research consent for lots designated for marketing, research or validation purposes
  • · Experience with Medicaid billing
  • 6 months experience in utilization review in a behavioral health setting
  • At least one(1) year experience in psychiatric nursing and utilization review
  • Utilizing standard procedures, conducts quality review and analysis of the work performed by staff supporting a specific line of business or functional area
3

Skills For Quality Review Coordinator Resume

  • Understanding of range of treatments needed by transplant patient population
  • + Continually improve review quality and consistency though reviewer auditing, review trend analysis and sustaining a continual learning feedback loop
  • A competitive compensation/benefits package including 401(k) with company matching
  • Work closely with Manufacturing and Quality to resolve any discrepancies uncovered during batch records review
  • Initiate reworks when applicable for nonconforming product to ensure they are conforming
  • Assists with bi-weekly Level I and field operations performance reviews, ensuring that staff is adhering to current procedures, policies, and processes
  • On-the-job training including paid CEU opportunities, career development and advancement opportunities
  • Data processing systems as relating to Utilization Review
  • Record keeping and reporting procedures
4

Skills For Concurrent Review Coordinator Resume

  • Capability of adapting to varying workloads and work assignments on a constant basis
  • + Responsible for ensuring marketplace integrity and consistency for image and supporting metadata quality evaluation
  • Proficiency in using Microsoft Word and Excel ,Cerner, FormFast and computer systems
  • Prepare reports and presentations using PowerPoint, Excel, or other programs
  • Clinical assessment and critical thinking
  • Two to three year’s data processing & customer service
  • Managed Long-Term Care Facility in Nassau looking for a Utilization Review Coordinator to join their team
  • Currently serving as a Utilization Review Coordinator and eligible for transfer; OR
5

Skills For Retrospective Review Coordinator Resume

  • Assists admissions with screening patients on the pre-hospitalization level to ensure admission criteria are met
  • · Monitor OR/Cath lab schedules for missing authorization/certification numbers and report to UR nurses any deficiencies
  • Provide training to the individuals involved in the documentation process
  • Chair and/or serve as a member of committees, as assigned to including Chairperson of Valley Ridge Incident Review Committee
  • Monitors and ensures accurate billing
  • Assists in maintaining the Utilization Review program for the Patient Business Services Department
  • Review processing batch records for compliance with all specified requirements and procedures
  • Quarantine product as deemed necessary for identified non conforming product
6

Skills For Principal Review Coordinator Resume

  • Complete transactions as deemed necessary for acceptable or non conforming product
  • Compile and perform trending of issues encountered at batch record review to identify any drift in performance or potential issues
  • Performs reviews of aging ticket reports and escalates issues as necessary
  • Escalates recommendations for training in Level I support teams
  • Attends weekly physician meetings to give/gain information regarding discharge plans of patients
7

Skills For Document Review Coordinator Resume

  • Determines patient discharge needs within managed care counseling
  • Paid training; Holiday pay
  • · Paid training; Holiday pay
  • Working in Health Care field required
  • Continued Self Improvement courses & seminars related to position along with “In House” programs provided by Alere Home Monitoring
  • Regulations of intermediary agencies pertaining to hospital stay coverage (e.g. Medicare and Medi-Cal)
  • Stable emotional makeup required to work in a fast paced environment with frequent interruptions
  • Provides timely, relevant, and accurate review of program documentation and processes
  • Provides a review of medical records and outcome data for quality management identified areas based on QM activities, high risk, high volume areas, and elements requited by accrediting bodies including CMS, TJC, etc
8

Skills For Plans Review Coordinator Resume

  • Provides interpretation of relevant resources including but not limited to DSM V, PDR and Physician’s Drug Reference Book, TJC and CMS standards of care, etc
  • Provides interpretation of documentation in medical records, other reports, and requirements as they relate to the nursing practice and make recommendations for improvements
  • Provides staff education regarding standards of practice and accrediting bodies’ requirements, facility policies and procedures as well as SOP’s
  • Collects data, produce reports, analyzes data, facilitates performance improvements, and makes presentations to Quality Improvement Committee and others
  • Lead and coordinate network of Deal Review contacts in Regions
  • Work with the Accounts Operations team to develop a standard EMEIA Deal Review approach for G360 and Core
  • Set up a timeframe and project plan to implement this approach across the Regions
  • Build a picture of Deal Review maturity amongst the Regions and create a tailored approach for each
9

Skills For Risk Quality Review Coordinator Resume

  • Learn best practice approaches and share with Regions
  • Monitor student document completion, alert partner-staff groups when student intervention is needed
  • Track and perform initial review of applications and/or documents required for Strategic Partnerships department and team members to perform business functions nation-wide
  • Track and perform initial review of Partner-level documents to support the Director of Contracts & Compliance and eliminate operational issues down-stream
  • Special projects as assigned by the Director of Education Partnerships Operations & Product Development
  • Act as a successful team member by being receptive to feedback/coaching, follow standard operating procedures, display reliability and have a willingness to develop and consistently improve
  • Review and process all initial enrollment documents, specifically required for students to enroll in corporate grant programs; annual renewal documents, required for students to remain eligible for corporate grant programs; all course-by-course proof of funding documents
  • Track and perform initial review of applications and/or documents required for Education Partnerships department and team members to perform business functions nation-wide
  • Excellent computer skills, including proficiency in database and spreadsheet applications
10

Skills For Bill Review Coordinator Resume

  • Good analytical and problem solving skills. Ability to work with computerized clinical information systems
  • Excellent verbal and written skills, initiative, flexibility, integrity and diplomacy
  • Maintain effective reporting systems
  • Current Utilization Review or Case Management experience
  • Experience in GMP environment
  • Experience in Quality, Science, Biologics or related field

List of Typical Responsibilities For a Review Coordinator Resume

1

Responsibilities For Utilization Review Coordinator Resume

  • Demonstrates on a consistent basis the behaviors that comprise The Basics of Service Excellence
  • Pre-authorization/utilization review experience desirable
  • High level of organizational skill and ability to manage multiple tasks concurrently
  • Reviews details within the database for urgency, priority, and web feedback reports, identifying and escalating issues, as required
  • Transplantation experience desirable
  • Proficient in Word processing and data management software programs
  • Actively participates in patient rounds on a daily. Communicates any required follow up through Case Management progress notes
  • Educates Medical Staff, Clinical Staff, and Case Management regarding CMS/MediCal requirements and regulations. 1x1 with physicians (case specific), NEO – new staff, CM leadership team on a quarterly basis, ancillary departments
  • Acts as a liaison between physician office and insurance companies to ensure payment for prescribed medications, procedures, treatments and hospital admissions
2

Responsibilities For Architectural Review Coordinator Resume

  • Conveys treatment plan to third party payors
  • Maintains medical records in accordance with hospital and department policies and standards
  • Provides verbal and/or written clinical information as required to insurers/regulatory agencies in order to obtain authorizations. Documents all necessary information related to authorizations
  • Serves on departmental or interdisciplinary committees as requested
  • Obtain and interpret information in terms of specific needs for authorization process
  • Familiarity with various third party payors and implications of managed care
  • Performs necessary funding reviews on all correspondent loan packages. Reviews correspondent loan package for completion, requests suspense items and missing conditions and confirms accuracy of notes received from Correspondent Lenders
3

Responsibilities For Quality Review Coordinator Resume

  • Properly prepares all correspondent first mortgage loans for funding. Sets the loans up for funding on the core system, verifies APR's and performs QM validations and amortizations on T-Value as needed
  • Responds to phone inquiries to address Correspondent Lenders questions and concerns on loan fundings and provides quality customer service to Correspondent Lenders
  • Maintains expertise on critical lending regulatory guidelines (TRID, ECOA, HMDA, CRA, Reg Z., FCRA, etc.) and ensures that all internal and external auditing requirements are reviewed and met according to Bank guidelines
  • Generates assigned management reporting including insightful analysis and commentary to tell the story and provide a basis for action steps
  • · Assists in collection of service provision (planned, actual, over utilized) and current service information for program supervisor(s) for upcoming team meetings or service change review meetings
  • · Provides analysis to assure that service delivery (planned to actual) correspond in areas of service support hours and units, staff hours and assignments, payroll hours and billing tickets, etc
4

Responsibilities For Concurrent Review Coordinator Resume

  • · Establishes and monitors the regional office and storage filing systems to assure information is organized, complete, and retrievable for compliance audit file reviews
  • · Actively engages in on-going communication with AR coordinators and/or AR accountants via phone, email, group meetings, etc to facilitate timely resolution to outstanding issues and items pending payment for services provided to customers
  • · Assists in communication with Interdisciplinary Planning Teams to address areas of identified errors, corrections, or needed services related to billing units and over/under utilization areas
  • · Assures and maintains functional knowledge base and materials related to current and new funding Rules and Contracts, provides updates and information to supervisor and/others specific to impact on service delivery, authorizations, and utilization of services
  • Maintain documentation including but not limited to authorization/certification numbers, denials, and communication notes
  • Monitors phone and secure fax/email and communicate to UR nurses
  • Monitor authorization /certification report
  • Send clinical information to insurance plans
  • Assists with the implementation of the Electronic Health Records (EHR) System
5

Responsibilities For Retrospective Review Coordinator Resume

  • Functions as one of the EHR super users
  • Provides technical assistance to units on utilization of EHR
  • Conducts Quality Assurance reviews of individuals’ records as directed by the Quality Improvement director
  • Set next review date on Worklist for UR nurse
  • Monitor fax, phone and email. Communicate follow-up information to UR nurses
6

Responsibilities For Principal Review Coordinator Resume

  • Assist UR nurse staff with concurrent denials as needed
  • Monitor and trend reports as needed the Far West Division Centralized UR Department in-scope insurance plans
  • Obtains authorizations/certifications from insurance companies/third party payors for services provided at St. Jude
  • Assists in the development of Process Improvement tools in the Utilization Review Department and Patient Business Services
  • Make final determination regarding suitability of LifeCell products for final release of a lot to Finished Goods and/or other dispositions, including rejections
  • Generate Certificate of Conformances as deemed necessary
7

Responsibilities For Document Review Coordinator Resume

  • Investigate Non conformance and CAPA’s
  • Assist Supervisor with various projects and metrics as deemed necessary
  • Initiate change controls for the department. (ECO’s)
  • Reviews incidents opened by Level I and Level II agents to ensure quality and accuracy of data
  • Makes recommendations for process improvements and enhancements to Customer Relationship Management (CRM) support tools based on data reviews and research
  • Conducts ad hoc training requests for individual DIIT members and provides recommendations for process improvement, as needed, through a demonstrated awareness and understanding of current procedures, policies, and processes within the work unit
  • Serves as a subject matter expert on Service Desk processes and supports special, multi-group projects
  • Acts as liaison between PCS vendors and peak enrollment center staff to ensure that repairs are done in a timely manner
  • Provides feedback to the supervisor and keeps customers apprised of status and progress on unresolved service requests
8

Responsibilities For Plans Review Coordinator Resume

  • Performs reviews for appropriateness of admission and continued stay
  • Serves as liaison with medical staff and other clinical departments
  • Contacts third-party payers to obtain benefits for admission and continued stay
  • Provides timely and appropriate discharge plans for patients
  • Maintains documentation of discharge services provided
  • Keeps psychiatrists and treatment team informed of discharge plans
9

Responsibilities For Risk Quality Review Coordinator Resume

  • Attends team and therapy meetings; to provide consultation to treatment team
  • Quality assurance/improvement tasks include researching, studying, monitoring and reporting quality care issues and outcomes, communicating standards of care, initiating and coordinating related activities to improve care
  • Participates in internal and external audits for reimbursement, quality of care and utilization of resources
  • Represents the department/division at internal and external meetings
  • Preserves patient and staff confidentiality to ensure strict adherence to related privacy policies and regulations
  • Keeps abreast of health payer benefits, regulations and requirements, disease processes and treatment modalities, community standards of patient care, appropriate quality monitoring techniques, professional medical standards of practice, government, payers, and accrediting organizations' requirements
  • Monitor authorization/certification report
10

Responsibilities For Bill Review Coordinator Resume

  • Keeps a data base of referral sources
  • Acts as a preceptor and orients new staff
  • Researches, studies, monitors and reports quality care issues and outcomes, communicates standards of care, initiates and coordinates related activities to improve care, performs data analysis
  • Keeps abreast of State and Federal regulations and requirements, disease processes and treatment modalities, community standards of patient care, appropriate quality monitoring techniques, professional medical standards of practice, government, payers, and accrediting organizations' requirements
  • Participates in improvement teams and helps manage safety and improvement projects; Participates and/or leads improvement teams
  • Understands healthcare improvement methodologies
  • Understands change process and theory

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