Candy McElvane
San Francisco
Summary
Dynamic leader with extensive experience with more than 20 years at UCSF Medical Center, excelling in patient scheduling, insurance verification, and workflow management. Demonstrated success as a lead role in enhancing the authorization processes and minimizing denials, leveraging APEX/EPIC expertise and strong communication skills. Proven track record in driving team performance and improving clinic operations.
Overview
21
21
years of professional experience
Work History
Practice Coordinator III/Lead Auth Coordinator
UCSF Medical Center
11.2017 - Current
- Lead a team of three authorization coordinators in order to obtain and document insurance authorizations for established patient visits, referrals and procedures or ancillary services. Communicates clinical information from medical records authorization requests to insurance companies.
- Addressing and resolving escalated issues of day to day operations (Complex procedure Authorizations, changes to insurance regulations, etc.)
- Serving as a liaison to Practice Supervisor to advise on workloads, take lead action complex cases and intradepartmental initiatives, and provide direction on process improvements initiatives
- Demonstrates competency working with CPT codes and ICD-9 and ICD-10 for the purpose of scheduling and securing authorization.
- Works RFI workqueues to secure information for accurate billing submissions or to respond to denials such as retro authorizations, clinical documentation, and addended authorizations with add on CPT codes.
- Secures complex insurance authorizations for eye injections, medications, or testing and is able to track the authorizations for renewal based on insurance company driven limits of time frames or numbers of visits or services.
- Demonstrates competency working with HCPC codes and is able to look up and locate the appropriate codes for the purpose of requesting authorization
- Understands how to identify and interpret a patient’s insurance benefit package. Utilizes this information to direct authorization requests and to coordinate these services for patients.
- Identifies trends in denials and works with practice team and supervisors to develop and implement improved workflows to minimize denials.
Practice Assistant III/Clinic Surgery Scheduler
UCSF Medical Center
02.2012 - 11.2017
- Coordinate and schedule all outpatient and inpatient surgeries for three surgical doctors.
- Ensure that all surgical procedures are scheduled within a clinically appropriate time frame.
- Assist patients, physicians, and hospital staff to ensure adequate communication regarding all aspects of coordinating/scheduling all pre and post op appointments with surgeon, in addition to biometry and anesthesia clearance.
- Coordinate patient transportation to and from hospital, as well as work with social workers to address other patient needs related to surgery.
- Support all functions of the clinical teams including but not limited to: Patient scheduling, telephone encounters, referrals, scanning, filing, authorizations, and billing.
Practice Assistant II/Call Center
UCSF Medical Center
02.2004 - 02.2012
- Provided support to all functions of the Ophthalmology Department including but not limited to: CRM messages, telephone encounters, referrals, APeX in-baskets, scanning, scheduling, filing, authorizations, and billing.
- Maintenance of all routine clerical operations and communications.
- Educated patients regarding appointment details while adhering to the UCSF House and Telephone Standards and is sensitive to the needs of patients, staff and providers at all times.
Education
Associate of Arts - Business Administration
City College of San Francisco
San Francisco, CA 06-2026
Skills
- APEX/EPIC
- Microsoft Suite/Type 50wpm
- HIPAA compliance
- Medical Terminology
- Office administration
- Patient scheduling
- Insurance verification
- Appointment coordination
- Electronic health records
- Schedule management
- Workflow management
- Healthcare and clinic operations information technology
- New hire training
Timeline
Practice Coordinator III/Lead Auth Coordinator
UCSF Medical Center
11.2017 - Current
Practice Assistant III/Clinic Surgery Scheduler
UCSF Medical Center
02.2012 - 11.2017
Practice Assistant II/Call Center
UCSF Medical Center
02.2004 - 02.2012
Associate of Arts - Business Administration
City College of San Francisco
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