Paula Castelly
Douglasville
Summary
Healthcare professional with robust understanding of patient referral systems and proven ability to streamline processes for improved patient care. Known for strong collaborative efforts within teams and consistently achieving desired outcomes. Reliable and adaptable with expertise in managing patient data and coordinating with healthcare providers.
Overview
24
24
years of professional experience
Work History
VA Referral Coordinator
Alliance Spine and Pain Centers
02.2021 - Current
- Responsible for creating and completing internal and external referral request received.
- Communicate directly with patients, referring offices, and our physicians, including fielding initial calls from potential patients that may last up to 20 minutes.
- Receive, review and process all new patient referrals, obtain medical records, scan records in patient chart and attach referral. Create incoming referral, and outreaching to the patient to schedule. Verifying insurance benefit coverage information for new and established patients.
- Meet weekly productivity requirements
- Ability to work independently, efficiently and accurately to ensure an ideal patient experience.
Population Health Management
Atrius Health
06.2019 - 06.2020
- Conduct data analysis and prepare Excel spreadsheets and PowerPoint slides relevant to site’s goals and performance on quality metrics.
- Assist in data extraction and preparing data analysis for Roster reviews with the physicians.
- Manage a high volume of patient outreach for patients with chronic disease (diabetes, hypertension and cardiovascular.
- Builds relationships with patient in order to assist the primary care team in developing an effective and accessible plan of care and ultimately track adherences to this plan of care.
- Reviews and analyzes population and data related to clinical care outcome, to evaluate performance, reveal trends, and identify opportunities.
- Utilized the population health registries to manage patient data generate practice reports, and to identify opportunities to improve clinical workflow and quality accuracy.
Patient Navigator II
Atrius Health
04.2017 - 05.2019
- Coordinates complex appointment scheduling linking referral and ancillary services required for assigned services within the organizations.
- Ensure required referral has been processed correctly and authorized prior to the patient’s medical appointment.
- Manage and process external referral through Epic work queues
- Obtain authorization and confirm eligibility coverage’s using various portals (Emdeon/HPHC Connect/NHP/ United Health/Nehen and Trizetto.
- Researches referral request to determine medically necessity and when appropriate encourage our patient to utilize our internal specialist providers.
- Communicate approval and denial of referral authorization to patients and referring physician
- Maintained liaison with insurance company and physicians to ensure completion of referral.
Medical Assistant II
Atrius Health
08.2002 - 04.2017
- Provide patient care including escorting patient to examination rooms, take and records vital signs, collect and document patient health status, history and documents.
- Performs EKG’s Holter monitor hook up, throat cultures, urine dipsticks, finger sticks, HCG level test, point of care testing, assemble kits for autoclave cleaning and setting up sterile fields for minor office procedures.
- Assist surgeons with minor office procedure (Fine needle aspiration, myringotomy, I&D, skin lesion excisions, IUD insertion, Colposcopy, endometrial biopsy, urodynamic studies, bladder instillations, cystoscopy, vasectomy.
- Ensure examination rooms are clean and stocked after each patient usage and appropriate disposal or contaminated material.
- Participates in prescription management tasks including pending of new prescriptions and renewal requiring clinician approval, prior authorizations and medication reconciliation.
Education
AS degree - Healthcare management
Bunker Hill Community College
Charlestown, MASkills
- EClinicalWorks
- Epic
- Proficient in MS Office Word, Excel
- Health Share Referral Manager
- MS Outlook
- Typing 60 wpm
- Excel
- Medical Terminology
- Quality Metrics
- Insurance Verification
- Pre-authorization
- Time Management
Timeline
VA Referral Coordinator
Alliance Spine and Pain Centers
02.2021 - Current
Population Health Management
Atrius Health
06.2019 - 06.2020
Patient Navigator II
Atrius Health
04.2017 - 05.2019
Medical Assistant II
Atrius Health
08.2002 - 04.2017
AS degree - Healthcare management
Bunker Hill Community College