Review Coordinator Resume Samples

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D Morissette

Darrell

Morissette

403 Turner Oval

Detroit

+1 (555) 529 4376

403 Turner Oval

Detroit

Phone

p +1 (555) 529 4376

Experience Experience

San Francisco, CA

Document Review Coordinator

San Francisco, CA

Koepp and Sons

San Francisco, CA

Document Review Coordinator

Assist with implementation of work flow productivity improvements
Helps to identify issues in current processes and assists in providing recommendations to management regarding solutions for those issues
Assist with any special projects as directed by manager
Create, edit and modify documents through change management
Performs related duties as assigned
Perform iSynergy tasks such as reviewing, gathering, preparing and sending out appeal packets and (medical record) documents
Reviews, edits and uploads documents, forms and letters

Detroit, MI

Utilization Review Coordinator

Detroit, MI

Abshire and Sons

Detroit, MI

Utilization Review Coordinator

Manage incoming calls from providers, managing requests for services from providers and Plan staff
Maintains courteous, professional attitude when working with all insurance providers, hospital and physicians providers and health plan patient
Identifies and communicates to treatment team and contracted insurance providers high risk cases for case management referral
Develop relationships within the provider community and health services team
Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance
Timely identifies and communicates to insurance providers all issues and concerns related to the case at hand
Performs other duties as requested

present

Philadelphia, PA

Architectural Review Coordinator

Philadelphia, PA

Ziemann, Satterfield and Abshire

present

Philadelphia, PA

Architectural Review Coordinator

present

Maintain a positive working relationship with fellow Associates, Homeowners, and Visitors
Work closely with other Associates as well as the DRC members and consultants in a professional manner
Document, track, and update architectural requests in Connect
Interact with homeowners regarding architectural inquiries, application results, and the architectural processes
Follow and exemplifies FirstService Residential's Global Service Standards and Core Values
Follow the proper architectural procedures as outlined in the Association's governing documents, department's policies, and as otherwise directed
Maintain accurate and complete records of homeowner communication and architectural submittals

Education Education

Bachelor’s Degree in Nursing

Tulane University

Bachelor’s Degree in Nursing

Skills Skills

Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner
Knowledge of medical and insurance terminology
Ability to work independently without supervision
Knowledge of individual, group and family therapy dynamics and techniques as related to cultural, social, economic, communication and role expectations within family systems
Ability to meet or exceed Performance Competencies
Ability to work in a team environment
Ability to speak, read, write, and communicate effectively
Knowledge of ICD9 and CPT coding
Excellent oral and written communication, including presentation skills
Detail Oriented

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Quality Review Coordinator Resume Examples & Samples

Airline Pilot/Copilot/Flight Engineer
Business Development
General
Supply Chain Management

Emeia Deal Review Coordinator Resume Examples & Samples

MBA with 8+ yrs of experience
Expert level knowledge of sales methodologies
Analysis and reporting
Business planning and management
Communication and presentation
Customer focus and relationship building
Information and technology proficiency
Proactively assists with the identification of training and development requirements of the team. Presents findings, and works with the manager and other personnel to design and implement training and development initiatives that will continuously upgrade the skills and capabilities of personnel with in the team
Proven ability to develop, document and maintain operational policies and procedures, including the designing and documenting detailed process flows, and the development of operational performance and quality metric standards and reports
Proven experience working with Excel and developing and maintaining various analyses and reporting tools
Resourceful, self-motivated, self-starter
Passionate about winning/succeeding
Advanced skills in Microsoft Office applications, specifically Word, Excel and PowerPoint
Knowledge of MS Project/Viso

TTS Global Trade Deal Review Coordinator Resume Examples & Samples

Coordinate and manage Global Deal Review, including the submission and distribution of GDR materials and maintenance of the GDR minutes and supporting documentation
Assist the Deal Review team with projects supporting the Global Trade business such as presentations, regulatory audits and discrete financing opportunities
Create exposure reports for Global Trade initiatives and programs
Liaise with other functions and regions of Trade in support of the Deal Review processes
Familiarity with Citi's Risk Policies and Procedures
High Proficiency in MS Excel, PowerPoint and Word
Excellent Organizational skills
BA in business or other relevant field of study required

Quality Review Coordinator Resume Examples & Samples

Knowledge of quality management methods, tools, and techniques used to create and support an environment that meets the needs of the organization
Understanding of effective communication concepts, tools and techniques; ability to effectively transmit, receive, and accurately interpret ideas, information, and needs through the application of appropriate communication behaviors
Knowledge of coaching concepts and methods; ability to encourage, motivate, and guide individuals or teams in learning and improving effectiveness
Understanding of the necessity and value of accuracy and attention to detail; ability to process information with high levels of accuracy
Knowledge of techniques and tools that promote effective analysis and the ability to determine the root cause of organizational problems and create alternative solutions that resolve the problems in the best interest of the business
Knowledge of and ability to create, implement, evaluate and enhance processes in internal controls
Knowledge of and ability to bring a reported problem to successful resolution

Scientific Review Coordinator Resume Examples & Samples

Responsible for the management of the protocol review process including review all new and revised protocols for scientific merit and ongoing progress monitoring. Ensure all new studies are processed and registered in NOTIS, perform preliminary review of protocols and/or revisions and ensure all associated documents are submitted, assess each protocol and determine appropriate level of reviews, assign reviewers, prepare and distribute protocol materials for review. This regularly involves educating PIs and coordinators of processes and NCI requirements
Successful completion of a full 4-year course of study in an accredited college or university leading to a bachelor's or higher degree and three years of experience in a research environment and/or administrative experience
Previous coordinating experience (e.g., meeting coordination, program coordination, clinical coordination, etc.)

Utilization Review Coordinator Resume Examples & Samples

Respond to incoming provider faxes and calls
Develop relationships within the provider community and health services team
Resolve service inquiries which could include: Notification entry, Providers status of an existing notification and determining if notification is required, Complete notification wizard along with ICD-10 and CPT coding, and Research of provider concerns and issues
Manage incoming calls from providers, managing requests for services from providers and Plan staff
Organize work and develop strategies to adapt to constantly changing workload as evidenced by: Performing multiple administrative tasks while concurrently triaging phone calls and incoming faxes and Timely response to provider and care coordination team needs
Document within the clinical documentation system administrative actions, follow-up and key attributes necessary to track member setting of care and reportable indices
Responsible for the resolution of escalated calls that are received by the UR team
Document Member/Provider responses and call outcomes in CareOne as appropriate
1+ years of professional experience working in an office setting using the telephone and computer as the primary instruments to perform the job duties
1+ years of experience in a Clerical or Administrative support role
1+ years of experience using a computer and Microsoft Office (Word, Excel, and Outlook)
Medical Terminology and ICD-10/CPT coding experience
Knowledge of Medicaid and Medicare
Experience working in a Hospital, Physician’s Office, or Clinic environment

Appeals & Grievance Case Review Coordinator Resume Examples & Samples

Demonstrates regular, reliable and predictable attendance
Receives documents regarding members’ complaints, ensures all information is provided such as the member complaint, response from the provider, copies of denial letters, authorizations and medicines, and assembles the case in standardized order
Analyzes member complaint documents, puts them in chronological order, and enters the data on the case form located in the Appeals & Grievance system (MACESS)
Acquires additional information needed to review the case such as medical records
Prepares summaries of each case, capturing significant information/events, and presents each case to the Appeals and Grievance Nurse
Facilitates Independent Medical Review (IMR) submissions. Receives calls from Health Net’s Regulator Affairs Department with requests to have a case pulled, organized, and forwarded to them for review and submission to State or Federal regulators. Gathers additional data, if requested, on a member complaint
Facilitates same/similar specialty submissions. Compiles member complaints that need review by medical personnel outside of Health Net and completes forms before mailing/faxing
Scans and makes copies of case materials to be entered into MACESS
Minimum three years experience in Appeals & Grievances or similar medical field
Ability to comprehend and interpret policies, accreditation standards and State/Federal regulations
Personal computer skills with proficiency using MS Office (Word, Excel, Access)
Organization and prioritization skills

Document Review Coordinator Resume Examples & Samples

Perform iSynergy tasks such as reviewing, gathering, preparing and sending out appeal packets and (medical record) documents
Maintain catalog of part numbers and revision dates within department specific folders to allow staff to have access to the most current version
Reviews, edits and uploads documents, forms and letters
Create, edit and modify documents through change management
Performs quality checks on this information to ensure that databases and workflow systems are accurate and current materials available
Maintains records and prepares reports
Maintains tracking systems to ensure that open issues are resolved promptly
Follow all regulatory policies and procedures, privacy and security standards in accordance with Government agencies and insurance providers to include HIPAA requirements
Answers general phone calls in a professional manner and directs to the appropriate department as required
Helps to identify issues in current processes and assists in providing recommendations to management regarding solutions for those issues
Communicate with patients; declined credit card payments and payment discrepancies
Process mail, correspondence such as bankruptcy notices, verification of medical expenses
Reconcile Purchase Order Numbers from TPA invoices
Understand and adhere to business processes and procedures
Assist with implementation of work flow productivity improvements
Maintain a culture of accountability in area of responsibility
Assist with any special projects as directed by manager
Associate degree or equivalent
Two to three year’s data processing & customer service
Ability to use thinking and reasoning skills to solve problems
Ability to make decisions while following company procedures
Ability to focus on a goal and obtain a pre-determined result
Ability to utilize the available time to organize and complete work within given deadlines
Ability to communicate both in writing & verbally in a clear and concise fashion
Ability to reason and communicate with others in a professional manner
Ability to attend job related courses & seminars as required
Ability to perform effectively in current position
Ability to use equipment that is relevant to job functions and requirements
Ability to understand their position relative to overall company service processes
Detail & Team Oriented
Strong Computer/Software Skills
CSR Skills & Aptitude
Communication & Writing Skills
Organization/Time Management Skills
Human Relation Skills
Professional demeanor via phone and in person
Sitting at desk for long period working on computer using keyboard and phone

Quality Review Coordinator Resume Examples & Samples

Required: Nursing degree from an accredited university or relevant training in health care
Current RN Texas Licensure
Preferred: Bachelor’s degree in Nursing
Experience: Ten years in clinical nursing. Quality chart review/abstraction, and healthcare related regulatory and accreditation requirements
Knowledge: Understanding of quality principles, theories and tools. Including data analysis and a statistical background required
Analysis: Ability to perform computerized analyses and use data management, word processing, and presentation software as required
Understanding: Familiar with the healthcare environment and hospital administration
Organization: Develops and manages documentation systems ensuring accessibility and appropriate maintenance; prioritizes work and the work of personnel
Time Management: Manages multiple projects and meets deadlines
Attention to Detail: Able to accurately document and communicate issues related to quality: peer review, regulatory compliance, patient safety, policies, bylaws, etc
Work Independently: Performs functions of the position with minimal or no direction
Independent Judgment: Able to independently determine when issues should be directed up the chain of command
Confidentiality: Assures confidentiality of issues and documentation in compliance with state and federal laws as well as medical staff bylaws and policies and procedures
Communication (strong written and verbal skills): Communicates with a variety of audiences; able to facilitate open and effective communication between staff, providers and administration
Interpersonal: Able to work effectively with multiple personalities and cultures; able to take both positive and negative feedback

Quality Review Coordinator Resume Examples & Samples

Review, investigate and make dispositions of parts or materials placed on Quality Review due to deviations from engineering specifications
Review and interpret applicable engineering detail and assembly drawings, engine manuals, clearance charts, engineering changes, and specifications to determine the severity of the material deviations
Make dispositions of parts and materials based on evaluation of technical requirements and end use
As required, develop and write rework & repair techniques that return parts to an acceptable condition
Evaluate Quality Notifications and related documentation for accuracy and completeness as received from both internal and external sources. Provide the necessary controls for storage and control of nonconforming material
Position will be located in North Berwick, ME
5 to 10 years of experience working with quality methods and procedures in manufacturing
Must be able to read, write, speak and understand English
Advanced shop mathematics for trigonometric and geometric computation
Ability to read and interpret Engineering Drawings
Flexibility around shifts, for training and to maintain workflow, to include overtime
Ability to manage multiple competing priorities simultaneously

Utilization Review Coordinator Resume Examples & Samples

Licensed clinical professional with current Georgia license preferred,
Or Registered Nurse (RN) preferred
Minimum five (5) years in psychiatric/chemical dependency setting with at least two (2) years on clinical team, experience with adolescents and adults
Previous experience with third party payors.Must be familiar with utilization negotiations
Reviews clinical record for all patients within one working day of admission for those admissions requiring concurrent or admitting input from UM
Ongoing review of clinical record

Utilization Review Coordinator Resume Examples & Samples

Able to multi-task and solve unique problems with insurance coverage in a creative and independent manner
Able to judge how to handle difficult situations with insurance companies and physician offices, balancing assertiveness with diplomacy
Works collaboratively with the Care Coordinators (as directed) to assist them in contacting post acute providers and confirming elements of successful patient transition to the next level of care
Refers denials in a timely manner to director or designee for review and appeal
Must have knowledge of medical terminology
Must have advance computer knowledge and must know Powerchart for patient records
Knowledge of Medicare and Medicaid payment rules, policies and regulations
Ability to evaluate medical records and other health care data
Ability to exercise good judgment and tact in relating to third-party payers, physicians and patients
Ability to establish and maintain effective and cooperative working relationships with Hospital staff and others contacted in the course of this position
Demonstrated ability to effectively prioritize multiple tasks and deadlines
Demonstrated ability to deal with problems involving several concrete variables in standardized situations

PRN Utilization Review Coordinator Resume Examples & Samples

Perform the utilization and review process, for continued stay, in an appropriate and timely manner
Maintain appropriate records of the review process for the purpose of preparing and submitting appeals to third party payers
Appropriately handle requests for information from medical records of patients in person, by mail or phone, from various sources from thecommunity at large, and assures that authorizations are properly executed (according to HIPAA guidelines, federal, and state laws) for these requests for client information
Attend and participate in pertinent hospital committee meetings
Maintain positive team relations with all staff, customer and guest relations, and maintains a courteous and professional manner in dealing withpatients, family members, visitors, physicians, and co-workers
Respect the confidentiality of patient and employee information
Conform to hospital policy regarding notification of absence or tardiness and PTO use
Perform other duties related to the department as necessity dictates
EDUCATION/EXPERIENCE
REASONING ABILITY

Retrospective Review Coordinator Resume Examples & Samples

Communicates through correspondence, the case disposition of ER PLP reconsiderations to the provider
Serves in all phases of the reconsideration process from preloading of cases, case disposition and letter generation. Prepares cases for scanning and archiving
Verifies eligibility, timeliness and record completeness of ER PLP cases and follows up with the provider as necessary
Electronically enters claim detail information in organization applications including Sidewinder and documents receipt, disposition and other noteworthy aspects of the cases in the application
Assists in resolving provider issues through the use of organizational databases and reports, communication with internal departments such as Claims and Appeals and contact/communication with ER PLP clinical coordinators and Medical Directors
Participates in process development and testing of new process implementation
Evaluates data input and output for accuracy and ensures compliance with data integrity and corporate compliance directives
Ensures timely processing and review of reconsiderations to meet departmental goals and state specific benchmarks for timeliness
Performs other duties as directed by the Manager and/or Director
1-2 years practical work experience in a claims, customer service, or health services environment
Ability to effectively communicate, present information and respond to questions from clinical and non-clinical Appeals staff, internal departments, providers and members
Ability to write concise, grammatically correct notes and business correspondence
Ability to review correspondence and system data to establish facts and draw valid conclusions consistent with applicable policy and procedures
Working knowledge of Microsoft Office Products including Outlook, Word and Excel
Knowledge of and/or ability to learn and use personal computers and industry software such as Peradigm, Sidewinder, and EMMA

Utilization Review Coordinator Resume Examples & Samples

Conducts initial reviews, monitors for appropriateness and need for referral to business office and/or physician
Conducts concurrent and extended stay reviews
Prepares and submits appeals to third party payors
Maintains appropriate records of the Utilization Review Department

Utilization Review Coordinator Resume Examples & Samples

Monitors admission and concurrent reviews of all patients, both internally and externally, as outlined in the Utilization Review Plan
Functions as hospital intermediary with external review agencies
Ensures that appropriate parties are notified in the event of an admission, or continuing stay denial
Manages utilization review data and information flow
Collaborates with hospital personnel and medical staff to ensure optimal patient care

Utilization Review Coordinator Resume Examples & Samples

Visits the hospital facilities or receives the documentation via fax and carries out the audit of the file or the clinical information, as appropriate
Discuss the cases with the psychiatrists, psychologists, or social worker for the care authorizations. 3. Maintains the daily census of the assigned facilities
Responsible for making sure that the physician to physician analysis takes place
Authorizes all the inpatient or partial hospitalizations
Issues the services authorizations after the audit is finished
Maintains updated in the system the cases' utilization review documentation
Maintains a log and reports in the system the ineligible cases
Provides the monthly utilization data of the facilities assigned
Maintains the cases registry updated by facility and account
Reports monthly the insured's post-discharge data
Keeps the specialization license and professional association membership (colegiacioacuten) effective
Complies with the continuing education hours that correspond to your specialization
Participates in the mandatory trainings, such as: the Annual Compliance Plan
Informs the supervisor or human resources of any sanction or revocation of your license that affects the practice of your profession
Comply with standards of Service Excellence Program
Available to travel throughout Puerto Rico

Risk Quality Review Coordinator Resume Examples & Samples

Develops criteria by which risk management needs within medical center may be assessed. Analyzes risk management data and prepares recommendations for the incorporation of risk management principles in each medical center
Provides support services to appropriate medical center staff in implementing risk management principles into credentialing processes
Assists in coordination of quality/risk management department activities with other medical centers
Promotes effective interaction among the medical centers in the establishment of risk identification systems, including the acquisition, organization and dissemination of information, data analysis and documentation
Makes recommendations for a clinical quality plan of action to the medical centers and satellite clinics when a confirmed quality issue is identified and follow up on the results of the action. May assist management in evaluating and formulating quality/risk quality and procedures, department goals and objectives. Compile risk management information for dissemination to all medical centers in a timely manner
Coordinates the medical centers collection and trending of statistical data from incident reports and quality assurance audits. Prepares summaries for existing computerized risk management database for tracking and trending data generated from the Medical-Legal Department. Reports all occurrences which may lead to medical center liability and follows up as necessary
Serves as a resource person for risk management activities in the medical centers. Participates in the design and implementation of the region Quality Outcomes and Improvement Program, inpatient and outpatient services; conducts clinical assessments; identify high risk areas; and develops care paths and outcome studies, as appropriate. Assists in the preparation of documents/coordination of regulatory site visits, including preparation of subsequent corrective action plans
Performs chart review for specific quality studies. Plans, develops and coordinates appropriate programs for risk management education in the medical centers and regional risk management seminars, including patient safety programs. Provides ongoing education and orientation to Kaiser Permanente physicians, quality staff, and outside providers of care as needed
Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser
Minimum five (5) years of experience in an acute care hospital setting
Previous experience within a quality improvement program
Proficient in mainframe and/or PC database, word processing preferred

Product Review Coordinator Resume Examples & Samples

Effective document review skills and understanding of GMP requirements. Experience reading batch records, drawings and documentation
Ability to interpret and evaluate data and summarize results. Experience recognizing problems and proactively taking corrective measures
Proficient in creating Excel charts, graphs and presentations
Maintains flexibility in a dynamic work environment
Ability to establish collaborative working relationships in a matrix organization internally as well as with a diverse / global supply base
LI-JR1

Periodic Product Review Coordinator Resume Examples & Samples

Perform reviews of the PPR process to ensure compliance and to suggest improvements based on these reviews to the PPR process
Support and provide requested documentation for internal and external audits/inspections. Ensuring function maintains audit readiness and completes regulatory audit actions in a timely manner
Archiving of all electronic files relating to PPR documents and hard copy PQR reports in accordance with the global records retention policy

Utilization Review Coordinator Resume Examples & Samples

Masters degree in a clinical discipline
LCSW, LMSW or LMHC
Experience in a healthcare environment
Strong communication, analytical and interpersonal skills

Utilization Review Coordinator Resume Examples & Samples

One to three years of applicable experience
LMSW, LCSW or LMHC
Strong communication and interpersonal skills to drive engagement and effectively collaborate
Proficiency with Microsoft Word and Excel

Utilization Review Coordinator Resume Examples & Samples

Accesses, triages and assigns cases for utilization review (UR)
Responds to telephone inquiries proving accurate information and triage as necessary
Enters demographics and UR information into claims or clinical management system maintains data integrity
Obtains all necessary information required for utilization review processing from internal and external sources per policies and procedures
Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary
Supports other units as needed
Knowledge of medical and insurance terminology
Knowledge of ICD9 and CPT coding
Analytical and interpretive skills

Bill Review Coordinator Resume Examples & Samples

Coordinates workload coverage for vacations, illness and leave of absence
Processes employee bills
Works closely with other departments ensuring client needs, incentives and contractual requirements are being met
Coordinates departmental training needs
Reviews policy and procedure changes and addresses with staff
Provides tracking reports to upper management; maintains updated staffing lists
Participates in meetings as requested by management

Utilization Review Coordinator Resume Examples & Samples

Current Registered Nurse (RN) license in Oregon
5 years of work experience in an acute care setting
2 years of additional work experience required in lieu of bachelor's degree
Knowledge of Utilization Review
Familiarity with insurance payors

Concurrent Review Coordinator Resume Examples & Samples

Conduct pre-certification reviews telephonically and concurrent review activities telephonically and onsite, applying appropriate criteria in order to determine that the services requested are clinically appropriate and in the appropriate setting
Travel to designated facilities for on-site review for concurrent review. This includes but not limited to meeting with the interdisciplinary team weekly. Travel on-site to designated facilities 2-3 times per week
Assist with discharge planning by discussing such plans with the admitting physician, hospital staff, recovery care facility staff, and other appropriate health care professionals
Coordinate necessary referrals with the Referral Team, Behavioral Health Services, the Catastrophic Senior Care Management Program, and/or the Clinical Care Management Team to facilitate continued care beyond the acute care setting
Identify and report potential quality of care issues to QM Department for further investigation and validation
Track physician non-compliance with UM Policies & Procedures and report to QM Department via physician profiling procedures
Understand and maintain compliance with NCQA, CMS and other necessary regulatory requirements
Assist in reviewing appeals and inpatient claims for problem resolution as necessary
Enter clinical information and other related UM data in a timely manner and in compliance with department policies and regulatory requirements, using appropriate computer systems of HAP
Provide a liaison service with various PHP and HAP departments that require interface with the
Registered Nurse (RN) or Occupational Therapist (OT) with current Michigan licensure
Minimum of three (3) years of experience in clinical management of patients in an Inpatient Setting or in Utilization Management, Case Management, Discharge Planning, Skilled Nursing Facility, Inpatient Rehab, or Home Care
An understanding of appropriate alternatives in the management of patients in an inpatient and outpatient setting
Knowledge of inpatient procedures and practices
Proficient computer skills - will be responsible for data entry of information into HAP systems
Travel on-site to designated facilities 2-3 times per week is required
Must work effectively with persons of varying position levels and diverse interests to reach consensus on resolutions of problems
Must be able to work effectively with physicians and hospital staff

Principal Review Coordinator Resume Examples & Samples

Review general transactions in all Principal Securities products to ensure they are in the best interest of the client. This may involve reviewing financial plans, analyzing products, and communicating with our Principal Advisor Network
Assist in liaison duties between Principal Securities Compliance and various Operations areas to ensure the smooth transition of business and to fulfill reporting requirements set forth by state and federal securities regulators. Assist Broker Dealer Operations and Princor Compliance to research, respond and settle formal customer complaints
Maintain comprehensive knowledge of all securities products and services offered by Principal Securities, and system capabilities of Principal Securities. This includes a sound understanding of applicable rules, regulations and understanding of system capabilities
Perform other job related duties, special projects, and transaction monitoring as required
Bachelor degree or equivalent 8 years work experience
2+ years of prior work related experience working with Mutual Funds and Annuities
Experience working with Stocks and Bonds is preferred
Active FINRA Series 7, 24 or 26 & 66 required
Active FINRA Series 53 and 4 is preferred
Goal oriented and results driven with strong leadership and time management skills
Strong communication skills including the ability to have difficult conversations
Basic computer skills and the ability to obtain knowledge of business unit software
High degree of accuracy with a strong attention to detail
Must be able to work independently in a fast-paced work environment to meet deadlines
Must be a FINRA associated person, which requires fingerprinting and a full background check

Utilization Review Coordinator Resume Examples & Samples

Three (3) to seven (7) years
Three (3) to four (4) year business office or hospital experience
Computer skills required

Architectural Review Coordinator Resume Examples & Samples

Follow and exemplifies FirstService Residential's Global Service Standards and Core Values
Maintain a positive working relationship with fellow Associates, Homeowners, and Visitors
Follow the proper architectural procedures as outlined in the Association's governing documents, department's policies, and as otherwise directed
Document, track, and update architectural requests in Connect
Conduct follow-up on application status or other items as needed
Be able to easily recall and communicate architectural requests and the homeowner's application details with the Design Review Committee (DRC) members and other Associates
Interact with homeowners regarding architectural inquiries, application results, and the architectural processes
Schedule and/or coordinate DRC meeting dates with homeowners, vendors, and the DRC in a timely manner, as needed
Complete DRC meeting minutes
Maintain accurate and complete records of homeowner communication and architectural submittals
Utilize technology as applicable to perform job functions
Report any safety or hazardous items immediately to supervisor
Attend team meetings, committee meetings, Board meetings, or industry functions as required
Maintain consistent and regular attendance
Work closely with other Associates as well as the DRC members and consultants in a professional manner
Any and all other assignments as deemed necessary by the Board of Directors or supervisor
Experience in property management or a closely related field
Minimum 1 year experience in an office environment
2 years customer service experience preferred
Have reliable transportation, a current California driver's license, and the current state mandated vehicle insurance
Ability to work with strong personalities and possesses strong internal/external customer relation skills
Ability to communicate effectively with all levels of Management, Associates, Members and others
Works well under pressure and in a fast paced environment
Demonstrates attention to detail and displays exceptional organizational and time management skills
Is able to work independently, prioritize daily workload, multi-task, and monitor progress for the successful completion of projects
Be flexible, able to take direction, offer valuable input, communicate effectively, and work as a team
Sees tasks and assignments through to resolution
Possess excellent written and oral communication skills and is proficient in English; other languages are a plus
Effectively communicate with the Board, Homeowners, or Visitors through written and verbal correspondence
Demonstrates awareness of variables which could affect associate retention and/or morale
Proficient in Microsoft Office applications at an intermediate level; including MS Word, Excel, PowerPoint, Outlook, and Publisher

Plans Review Coordinator Resume Examples & Samples

Evaluating building permit application packages against established division submission standards
Assigning review responsibilities to incoming permit applications based on the scope of work and assigning a job classification based on the complexity and cost of the project
Communicating information directly to customers (homeowners, developers, architects, engineers, and contractors) about construction permits and the permitting process
Resolving issues and answering questions related to permit applications, fees, and applicable submission standards for construction permits
Ability to read and interpret construction documents and technical specifications
General knowledge of the organization structure, mission, functions, processes, objectives and policies of the Department
Ability to prioritize and organize work assignments effectively
Ability to communicate orally and in writing in order to provide concise information to customers
Keyboarding (50 wpm)
Performing basic mathematical calculations
Using personal computers and related software applications appropriate to the division
Establishing and maintaining effective interpersonal relationships at all organizational levels and with the public

Utilization Review Coordinator Resume Examples & Samples

Experience: Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency field preferred
License/Certification
Skills: Good oral and written communication skills required to communicate in a clear and concise manner with patients, physicians, staff and administration
Physical Requirements: Work is sedentary requiring sitting most of the day. Sitting at least six (6) hours a day while processing paperwork, answering the phones and other described duties. One half of the day is spent on the telephone. Standing at least one hour a day while making copies, delivering messages, etc. Lifting up to 20 lbs of copier paper from floor level to check level while filling copier with paper
Other: Performs others duties as may be assigned by CEO

Funding Review Coordinator Resume Examples & Samples

Performs necessary funding reviews on all correspondent loan packages. Examples include, but not limited to: Reviews correspondent loan package for completion; Requests suspense items and missing conditions; and Confirms accuracy of notes received from Correspondent Lenders
Properly prepares all correspondent first mortgage loans for funding. Examples include, but not limited to: Sets the loans up for funding on the core system; Verifies APR's, performs QM validations and amortizations on T-Value as needed
Is able to use the Loan Originations systems, as needed. Examples include, but not limited to: Is able to properly access Loan Originations systems; Is able to process, fund, evaluate, underwrite, etc. loans as needed in the Loan Originations Systems; and Is able to support the team using Loan Originations Systems
Responds to phone inquiries on loan fundings, provides quality customer service to correspondent lenders. Examples include , but not limited to: Addresses correspondent lenders questions and concers, Provides quality service to correspondent lenders; and Receives positive correspondent lender feedback
Maintains expertise on critical lending regulatory guidelines and internal and external auditing. Examples include, but not limited to: Expertise in TRID, ECOA, HMDA, CRA, Reg Z., FCRA, etc.; and Ensuring that all internal and external auditing requirements are reviewed and met according to Bank guidelines

Utilization Review Coordinator Resume Examples & Samples

Responsible for writing appeal letters to insurance companies
Promotes a positive working environment and guest relations
Assumes and/or performs additional duties as requested
Promotes safety by attending mandatory inservices and complies with all safety measures initiated by the facility

Utilization Review Coordinator Resume Examples & Samples

Reviews insurance benefits, collects clinical and medical supporting data, contacts health plans for authorization of appropriate level of care based on medical necessity guidelines and benefits, participates in concurrent reviews and prepares and submits appeals
Demonstrates initiative, effectiveness and timeliness in collecting needed data for and then performing pre-certification and admission external reviews
Advises doctor of any third party patients in the conduct of external clinical reviews
Effectively advocates for patients in the conduct of external clinical reviews with third party payers
Demonstrates knowledge and understanding of Talbott Recovery Campus (TRC) and ASAM criteria for levels of care
Demonstrates initiative and effectiveness in coordinating patient-requested appropriate appeals to third party payers
Advise Primary Therapist of any change that occurs in patient's benefits status within 24hours
Advise patient/primary therapist of any adverse determination within 24 hours. Follow up with patient and primary therapist regarding patient's understanding of appeals process
Attends treatment team meetings as assigned, reviews weekly UR update information
Attends and participates in treatment team meetings and FLASH meetings
Coordinates patient's clinical and after-care needs with treatment team
Performs all other duties as assigned or required
2 years experience in Utilization Review in a mental health setting required

Utilization Review Coordinator Resume Examples & Samples

Assisting in the promotion and maintenance of high quality care through the analysis, review, and evaluation of clinical criteria as it relates to patient treatment and length of stay
Reviewing cases for appropriateness of admission, continued stay, and discharge planning
Managing and effectively utilizing insurance benefits through timely prospective, concurrent, and retrospective review activities
Maintain an open communication system with internal and external entities, both through written documentation and verbal exchange regarding patient treatment
Communication with internal and external entities to facilitate good customer relations and acquisition of resources
Complies with all Administrative, Clinical, and HR policies and procedures
Maintains an awareness of patient funding sources, discharge planning needs, and available resources in order to facilitate continuity of care
Supervises, plans, and organizes the functions of the facilities Case Management system to minimize denials of payment
Manages, prepares, and submits appeals to third party payers on clinical denials
Formalizes the UR Program and establishes CQI goals and outcome indicators
Reviews payer contracts and regulatory requirements on an on-going basis, updates pertinent policies and procedures, and trains staff on special requirements
Attends meetings as scheduled
Contributes to UR program goals and objectives in containing health care costs while maintaining a high quality of care
Performs prospective, concurrent and retrospective telephonic reviews for inpatient Mental Health and Dual Diagnosis services
Collects only pertinent clinical information and documents all UR review information using the HMS software system
Promotes alternative care programs and researches available options including costs and appropriateness of patient placement in collaboration with discharge planners and patient
Communicates directly with the designated medical director and management staff regarding all inpatient cases and requests for health care services that do not meet medical necessity criteria
Maintains an active role in assuring the continuity of care for all inpatients through early discharge planning and working with hospital and health plan patient discharge planners and social worker in the early identification of potential home care candidates or less restrictive level of care placement
Communicates all UR review outcomes in accordance with the UR policy and procedure
Follows relevant time frame standards for conducting and communicating UR review determination
Maintains and submits reports and logs on review activities as outlined by the UR program procedures
Identifies and communicates to the CFO and CEO, Physician provider, treatment team, and insurance team concerns and issues
Identifies and communicates to the CFO and CEO all potential quality of care concerns
Serves as liaison and advocate for both the patient and his/her treatment team as related to insurance authorization for continued treatment and discharge planning
Maintains courteous, professional attitude when working with all insurance providers, hospital and physicians providers and health plan patient
Identifies and communicates to treatment team and contracted insurance providers high risk cases for case management referral
Active participation in treatment team meetings
Timely identifies and communicates to insurance providers all issues and concerns related to the case at hand
Communicates effectively to the patient any issues or concerns related to insurance authorization or benefit determination
Communicates and collaborates in a courteous and professional manner with the patient, practitioner, provider and multidisciplinary health care team members all issues, concerns or revisions to the UM Procedure
Serves as a liaison and patient advocate when deemed applicable for quality of care and cost outcomes
Communicates appropriately and according to policy with the practitioner(s), provider(s), patient or patient's legally appointed representative any UR coverage determination(s)

Utilization Review Coordinator Resume Examples & Samples

Responsible for conducting external precertification for treatment, reviews and maintaining documentation
Submits daily UR log update to administrative assistant
Conducts morning census meeting to review planned discharges and upcoming reviews
Maintains communication with physician and clinical staff to insure current knowledge of patient specific needs and plans
Understand patients' benefit limitations to facilitate appropriate benefit utilization
Assists in appeal process as it relates to payor denial
Ongoing knowledge of provider contracts, fee rates, exceptions, and contractual expectation
Completes HMS entry for UR notes and updates
Faxes clinical data to foster care agencies to facilitate hands off communication n bsp
Attends weekly treatment team meetings

Utilization Review Coordinator Resume Examples & Samples

Three (3) years related medical experience
Six (6) months experience in a hospital environment required
Utilization review experience preferred
Experience with InterQual guidelines and Cerner systems preferred
Must possess a current Tennessee State Board of Nursing license if primary residence is Tennessee or a Nurse Licensure non-Compact state
Must possess a current State Board of Nursing license in the state of primary residence if the state is a Nurse Licensure Compact state

Utilization Review Coordinator Resume Examples & Samples

1 – 2 years of Medical Utilization Review and/or Care Coordination experience preferred
Experience with healthcare systems in an Internal Medicine or Family practice setting is highly preferred
Strong preference for management experience with training and education
Strong proficiency and experience with data analysis
Experience with electronic medical records preferred

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