Debra Mascarelli
Sun City
Summary
Seasoned LPN with extensive experience in patient care coordination and clinical documentation, notably at United Healthcare/Optum Hospice & Palliative Care. Excelled in streamlining intake processes, enhancing patient satisfaction by significantly reducing wait times. Skilled in prior authorizations and effective phone engagement, demonstrating a strong commitment to healthcare team collaboration and regulatory compliance.
Overview
16
16
years of professional experience
Work History
LPN / Prior Authorization Nurse
WellCare Health Plans Inc. / CENTENE Management Co
03.2018 - 12.2024
- Reviewed medical documents, records required for authorization review to determine medical necessity for requested procedures, lab and imaging.
- Data entry of authorization review, making determination to approve authorization or to send for medical review.
- Follow through of approved authorizations by letter. Notifying requesting providers by phone and determination letter follow MD denial of authorization request.
- Requesting additional medical documents, uploading upon receipt of requested documents.
- Providing quality customer service to providers calling with questions or requesting updates on status of authorizations.
- Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
Clinical Review Nurse / LPN
TriWest Healthcare Alliance
01.2017 - 02.2018
- Provided quality customer service to Veterans
- Reviewed medical records to determine medical necessity for authorizations.
- Compiling information necessary to process authorizations and referrals.
- Created authorizations based on the criteria of the TriWest benefits programs.
- Contacted providers to obtain additional medical information, or documents, required.
- Data entry of authorizations and other pertinent data, uploading documents.
- Ensured timely reviews for Veterans, facilities and providers.
- Provided assistance to our Veterans in finding providers in the area the lived, set up transportation, obtained approval and set up air travel for Veterans out of ground transport area (Guam).
- Providing quality customer service to providers calling with questions or requesting updates on status of authorizations.
- Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
LPN /Patient Intake Coordinator /Office Administrative Assistant
Premier Home Health
02.2016 - 10.2016
- Set up new home health program, completed all necessary requirements for government inspections for Medicare contract, assisted with interviews of home health positions, set up offices, ordered medical supplies, any and all activities required in setting up new home health agency.
- Managed daily referrals, prior authorizations, completed Medicare, PECOS, OIG verifications.
- Assessed patient medical needs and determined if patient qualified for services.
- Coordinated communication between patients and medical staff to transition from referral to admit.
- Created, maintained, referral logs, spreadsheets, census, reported accurate census daily.
- Maintained daily scheduling and monthly on-call calendars.
- Established, maintained positive relationship with referral sources, physicians and patients.
- Completed accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
- Responded to patient requests with appropriate clinical and personal assistance.
- Educated patient on intake procedures, enhancing patient preparedness and engagement.
- Enhanced patient satisfaction by streamlining intake processes, reducing wait times significantly.
- Assigned nurses, Occupational and Physical therapist to do admissions.
- Supported home health manager with operational requirements, administrative tasks, setting up interviews, meetings, any and all task as assigned.
LPN / Patient Care Coordinator Sr /Clinical Intake Coordinator
United Healthcare/Optum Hospice & Palliative Care
11.2008 - 02.2016
- Managed referrals, verified insurance, obtained prior authorization, data entry of referrals
- Coordinated communication between patients, medical staff to transition from referral to admit.
- Established, maintained positive relationship with referral sources and physicians
- Answered incoming phone calls from patients to provide basic assistance and triage medical concerns, directed to appropriate discipline as needed.
- Maintained scheduling for physician face to face encounters aper Medicare guidelines.
- Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
- Created & maintained accurate daily / monthly census and referral logs, spreadsheets.
- Implemented, maintained IDG meeting agenda, documents, tracked Medicare re-certifications. Effectively managed activities for multiple interdisciplinary teams of 70 to 80 patients.
- Collaborated with interdisciplinary team to address patient needs through effective intervention and care planning.
- Monitored, tracked, and conveyed important patient information to healthcare staff.
- Effectively managed activities for multiple disciplinary teams of 70 - 80 patients.
Education
Practical Nursing - Practical Nursing
Phoenix Union Area Vocational Center (a.k.a. Metr
Phoenix, AZ02-1973
Skills
- Prior Authorizations, creating, processing,
- Patient Admission Coordination
- Patient Care Coordination
- Clinical Documentation
- Data enrty
- Effective Phone Engagement
- Healthcare Team Collaboration
- Accurate Order Documentation
- Clinical Documentation Management
- Practical Nursing License in Arizona
- Medical documentation
Timeline
LPN / Prior Authorization Nurse
WellCare Health Plans Inc. / CENTENE Management Co
03.2018 - 12.2024
Clinical Review Nurse / LPN
TriWest Healthcare Alliance
01.2017 - 02.2018
LPN /Patient Intake Coordinator /Office Administrative Assistant
Premier Home Health
02.2016 - 10.2016
LPN / Patient Care Coordinator Sr /Clinical Intake Coordinator
United Healthcare/Optum Hospice & Palliative Care
11.2008 - 02.2016
Practical Nursing - Practical Nursing
Phoenix Union Area Vocational Center (a.k.a. Metr
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