Pros: health benefits and yearly incentive
Cons: long sit times, technical problems such as slow systems or down time
I enjoyed working with professionals in the medical field they ranged from Nurses, Therapist, Licensed Clinical Social Workers, Clinicians and retired Doctors. I would receive request from them to retrieve hospital readmission data and compile a report for them to review and evaluate. I Assigned members with qualifying diagnosis of Heart Disease, Renal Failure, and Respiratory Ailments to the clinical personnel for further evaluation. Reviewed medical records, prepare documents and scan for Behavioral and Case Management Clinicians. Maintain Case Managers reports such as Future Risk Cost, High Risk Pregnancies, and Productivity reports.
Data mined large quantities of data to identify high risk utilizations and route candidates to specific programs. Supported Personal Care staff by researching clinical data, contractual benefits, and reviewing Hospital Readmission Daily Census reports. Responded to request for history of controlled substance and pharmacy data and produced a reports for clinical and utilization clinicians to review. Compile monthly productivity totals and utilize data mining software to produce monthly reports for management to review. Post service claim review, communicated processing instructions pertaining to Providers or Facilities contracts. I learned medical terminology, how to read CPT and ICD codes. The most enjoyable part of my job was finding members to assign to Case Management where they would receive the appropiate level care by a licensed Nurse or Licensed Clinical Social Worker. The hardest part of my job was analyzing large amounts of data and sitting for long periods of time.