Celeste Fields Email and Phone Number

Demonstrating analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.Thoroughly investigating past client services subsequently reducing number of under/unpaid accounts. Strict adherence to federal and state guidelines for release of information. Appropriately and correctly identifiy errors and re-filed denied/rejected services as they were received. Prepare all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials or support appeals. Efficiently performs insurance verification and pre-certification and pre-authorization functions. Carefully review medical records for accuracy and completion as required by insurance companies. Interpret medical reports to apply appropriate ICD-9/10, CPT-4 and HCPCS codes. Examine diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered. Assign additional diagnosis codes based on specific clinical findings in support of existing diagnoses. .Meticulously tracked and resolved under and unpaid services as outlined in contract.

Provide necessary health education training for patients in symptom management and chronic care related to diabetes and heart failure with the goal of optimal self management and avoid unnecessary hospitalizations. Utilize strong assessment skills to determine necessary patient care. Clients further assisted with related chronic comorbidities diagnoses which include Hypertension, hyperlidpidemia and chronic kidney disease. Completed 1000+ hours of clinical work in diabetic education. Review MD ordered client plan of care, medications, diet review and aid in ftarget care referrals. Consult w/ MD when indicated.

Assisted Associate director in the coordination of nursing care subsequent to hospitalization or mandated by diagnosis and/or medical need including pre-auths and utilization mangement.

Focus - Cardiology Re: Heart Failure