China Hudson
Macon
Summary
Experienced Healthcare Professional with 24 years in clinical intake and care coordination. Specializes in Benefit Verification, Prior Authorization, and Medicare Advantage plans. Streamlined Medical Referral Management and ensured Healthcare Compliance to enhance revenue cycles and eliminate operational bottlenecks.
Overview
19
19
years of professional experience
11
11
years of post-secondary education
1
1
Certification
Work History
Care Coordinator
CECELIA HEALTH
Macon
01.2024 - Current
- Process intake and screen referrals to ensure clinical viability and financial reimbursement paths for every patient admission.
- Verify benefits and obtain prior authorizations for medical services and Medicare Advantage plans, specifically addressing I-SNP Knowledge requirements.
- Assign payer categories and develop mitigation strategies for potential revenue loss by securing reimbursement paths early in the referral-to-admission pipeline.
- Utilize Microsoft Excel and advanced communication skills to collaborate with healthcare providers and stakeholders on healthcare compliance and referral status.
CSR - Customer Service Representative
GOLDEN CUSTOMER CARE
01.2023 - 02.2025
- Maintain data integrity in HRIS and customer databases with accurate data entry of insurance and personal information.
- Resolve complex account issues and perform insurance contract review to ensure personalized service and accurate problem resolution.
Social Worker
DHHS NEBRASKA
Nebraska
06.2022 - 06.2023
- Streamline intake processing and application workflows for Medicaid and SNAP benefits, enhancing administrative efficiency.
- Screen candidates and conduct interviews to perform benefit verification and eligibility assessment for essential government services.
- Verify customer information and contribute to healthcare compliance initiatives through rigorous quality assurance training.
Customer Retention Specialist
ADT SECURITY SERVICES
05.2021 - 05.2022
- Collaborate across teams to streamline billing processes and resolve technical account management discrepancies.
Patient Care Advocate
CAREXM
Macon
08.2018 - 05.2022
- Obtain necessary documentation to streamline insurance claim processes and verify reimbursement paths, reducing processing time.
- Assign priority to urgent medical concerns by bridging communication gaps between patients and providers to enhance care coordination.
- Analyze patient feedback to identify systemic operational bottlenecks, proposing targeted improvements for care delivery.
Claims Specialist
HEALTHEQUITY INC.
Macon
03.2019 - 05.2021
- Process medical claims and verify documents for accurate payer category assignment and insurance company resolution.
- Verify patient advocacy outcomes through effective communication and insurance contract review.
Medical Receptionist
WOMEN'S HEALTH INSTITUTE OF MACON
Macon
02.2007 - 05.2009
- Executed medical billing and processed patient files to ensure accurate long-term care administration and effective lab inventory management.
Education
Bachelor's - Criminal Justice
STRAYER UNIVERSITY-GEORGIA
Macon, GA 06.2016 - 05.2020
Business Administration - Business
MILLER MOTTE TECHNICAL COLLEGE
Macon, GA 06.2009 - 01.2013
High school diploma - Criminal Justice
Southeast High School
Macon, GA 06.1997 - 06.2000
Skills
- Case Management
- Intake Processing
- Medical Referral Management
- Benefit Verification
- Prior Authorization
- Healthcare Compliance
- Medicare Advantage
- I-SNP Knowledge
- Payer Category Assignment
- Claims Processing
- Medical Billing
- EMR Systems
- Microsoft Excel
- Microsoft Office
- HIPAA
Certification
Criminal Justice Professional Certification, Strayer University-Georgia, 05/01/20
Timeline
Care Coordinator
CECELIA HEALTH
01.2024 - Current
CSR - Customer Service Representative
GOLDEN CUSTOMER CARE
01.2023 - 02.2025
Social Worker
DHHS NEBRASKA
06.2022 - 06.2023
Customer Retention Specialist
ADT SECURITY SERVICES
05.2021 - 05.2022
Claims Specialist
HEALTHEQUITY INC.
03.2019 - 05.2021
Patient Care Advocate
CAREXM
08.2018 - 05.2022
Bachelor's - Criminal Justice
STRAYER UNIVERSITY-GEORGIA
06.2016 - 05.2020
Business Administration - Business
MILLER MOTTE TECHNICAL COLLEGE
06.2009 - 01.2013
Medical Receptionist
WOMEN'S HEALTH INSTITUTE OF MACON
02.2007 - 05.2009
High school diploma - Criminal Justice
Southeast High School
06.1997 - 06.2000