Stacey Sheets Email & Phone Number

United States

Support UM/CM for multiple Medicare Advantage PlansAnalyze medical claims to ensure compliance with Medicare guidelinesManage Organization Determinations from start to finish: obtain information from member and/or provider including clinicals, diagnosis codes, CPT/HCPCS codes; input and process approval/denial based on medical necessity, EOC, or MD review; notify member and provider of decisionMonitor members for admissions and discharges and obtain clinical support as neededReview claims for accurate assignmentCreate PA cases for review (DME, surgeries, IP, SNF, LTAC, INR) and request supporting documentationProvide oversight of incoming QIO Appeals, upload documentation, and alert correct team ASAP due to tight turnaround timesMaintain tracking of QIO/OD/Appeals and reporting on trends to managementProvide subject matter expertise and feedback for process improvement and organization efficiency project in collaboration with multiple teams throughout the organizationAssess members following ER or Inpatient admission for gaps-in-care and providing resources as needed

Gloucester County, Virginia, United States

Responsible for registration of all patient types within their departmentWorks daily reports and account work queues to ensure the integrity of registration dataObtains or validates patient information and registers patients into the software system, while providing a high level of customer serviceEnsures all necessary demographic and financial data are obtained and documented into the systemMaintains patient safety through the correct patient identification practicesMaintains strict confidentiality in all matters relating to patient PHIHandles patient inquires related to registrationCompletes Advanced Beneficiary Notification and collects payments for services not medically necessaryCalculates payment information, accepts funds and credit accounts accordingly for Time of Service collectionsEnsures EMTALA rules and regulations are strictly adhered to when registering patients through the ED and ObstetricsEnsures Advance Directives are obtained when applicable