Carolyn Belich
Aliquippa
Summary
Detail-oriented individual with exceptional communication and project management skills. Brings strong commitment to quality and success. Recognized for adaptability and proactive approach to compliance with insurance, county, and state regulations
Overview
25
25
years of professional experience
Work History
Long Term Disability Senior Claims Manager II
New York Life Insurance Company
10.2022 - Current
- Outreach to employers and medical providers to determine eligibility for disability benefits
- Consult with medical directors, nurses, and team leader, to determine functional limitations in support of a claim
- Analyze and interpret disability policies to understand employer definitions and effective dates of coverage
- Manage up to 50 active claims and mentor new hires while meeting deadlines
- Submit claim decisions with 98% requiring no additional revisions from supervisor
- Long Term Disability Senior Claims Manager I
- Obtained claimant’s employment and medical information to determine eligibility for disability benefits
- Consulted with medical directors, nurses, and staff to determine functional limitations
- Complete daily compliance by tracking deadlines, updating information, and making timely decisions
- Manage up to 35 active claims and mentor new hires while meeting deadlines
Intake Service Coordinator
The Watson Institute
12.2016 - 03.2021
- Interviewed parents and assessed their child’s needs to identify the appropriate behavioral health services
- Developed rapport with outside providers and agencies, combining efforts to successfully obtains services for clients
- Verified eligibility of Pennsylvania Medicaid, managed care, and commercial insurances
- Compiled required documentation for insurance authorizations of behavioral health services
- Managed clinical staff by assigning new clients, maintaining schedules, and tracking the completion of evaluations, treatment plans, and progress notes
- Examined documentation to ensure compliance and accuracy, contributing to the reduction of reclaimed funds each year until the goal of zero was achieved
- Aided in fraud, waste, and abuse audits, and the establishment and implementation of corrective action plans
- Initiated discussions and proposed methods to improve processes, such as development and use of online intake forms for families in order to expedite the retrieval of completed forms to promote full testing schedules
- Reviewed billing claims by verifying the accuracy of International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT) codes
- Practiced HIPPA guidelines and remained updated on office, state, and county regulations
- Gathered service ratings via surveys for quality assurance, and generated and updated office and consent forms specific to the type of service
- Assistant Wraparound Service Coordinator
- Supported parents by explaining services, processes, answering questions, and resolving issues
- Completed and submitted packets and service plan of cares for payment of wraparound and camp services
- Recruited, interviewed, hired, trained, and created schedules for new employees
- Maintained wraparound program and camp enrollment
- Elected to attend trainings and coach staff on the navigation and use of the electronic records system
- Therapeutic Support Staff
- Provided support to children on the autism spectrum in the home, community, and school settings
- Developed and implemented activities and schedules for the first camp in Pennsylvania for autistic children
- Implemented interventions to modify and decrease negative behaviors, and to facilitate social interactions
- Obtained and recorded client data, and completed daily progress notes
Assistant Wraparound Coordinator
The Watson Institute
09.2005 - 12.2017
- Entered data, generated reports, and produced tracking documents.
- Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
- Enhanced operational workflows by maintaining well-organized documentation systems and updating records accurately as needed.
- Gathered and organized materials to support operations.
- Managed project timelines for successful completion, ensuring milestones were met and deadlines were adhered to.
- Enhanced customer satisfaction by responding promptly to inquiries and addressing concerns professionally.
- Collaborated with department heads to develop strategic plans aligning with overall company objectives, fostering a unified approach toward shared goals.
- Assisted in recruitment efforts by coordinating interviews and managing onboarding activities for new hires.
- Streamlined administrative processes, allowing for more efficient use of resources and better support for project teams.
- Supported successful project completion by meticulously reviewing and updating project plans to reflect changing needs and objectives.
- Increased client satisfaction by facilitating clear and consistent communication between project teams and stakeholders.
- Managed vendor relationships to secure best quality of services and products for organizational needs.
- Organized and maintained project documentation, enabling quick access to important information and facilitating smoother project transitions.
- Prioritized and managed multiple projects simultaneously, ensuring all met their deadlines and objectives without compromising quality.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
- Oversaw appointment scheduling and itinerary coordination for both clients and personnel.
- Delegated tasks to administrative support staff to organize and improve office efficiency.
- Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
- Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
Therapeutic Support Staff
The Watson Institute
09.2005 - 12.2007
- Supported clients'' emotional well-being through empathetic listening and tailored coping strategies.
- Created a safe, non-judgmental environment for clients to openly discuss their emotions, challenges, and goals during therapy sessions.
- Improved clients'' daily living skills by providing guidance in areas such as personal hygiene, communication, and social interactions.
- Conducted crisis intervention as needed to ensure the safety and stability of clients in high-risk situations.
- Enhanced therapy outcomes by implementing evidence-based practices and personalized treatment plans.
- Advocated for clients'' needs within the community, connecting them to appropriate resources and support services.
- Assisted school staff with implementing targeted interventions within classroom settings for improved academic performance among students receiving therapeutic support.
- Maintained detailed documentation of client sessions, progress notes, and treatment plans for accurate reporting and continuity of care.
- Trained family members on techniques to support their loved ones at home, enhancing the overall effectiveness of therapy initiatives.
- Continually pursued professional development opportunities to enhance therapeutic knowledge base and stay abreast of industry best practices.
- Utilized creative modalities like art, music, or play therapy when appropriate to engage clients in alternative forms of self-expression during sessions.
- Developed and implemented individualized behavior modification plans to reduce challenging behaviors and promote positive change.
- Documented patient information, treatment plans, and patient responses.
- Developed strategies to help patients cope with stress and anxiety and build resilience.
- Developed and maintained relationships with referral sources to support continuity of care.
- Tracked progress according to goals for interventions.
- Educated clients and families on mental health issues to promote understanding and support.
- Attended continued education sessions to maintain professional standards and stay up-to-date with new developments.
- Provided crisis intervention to support clients during times of urgent need.
- Worked with interdisciplinary treatment team to develop treatment plans.
Therapeutic Support Staff
Northwestern Human Services
09.2000 - 09.2005
- Led group sessions focused on topics such as stress management, conflict resolution, or anger management to build essential life skills among participants.
- Collaborated with multidisciplinary teams for comprehensive client care and streamlined service delivery.
- Evaluated client progress by conducting regular assessments and adjusting therapeutic interventions accordingly.
- Delivered brief interventions to help clients develop healthy coping skills.
- Assessed clients' mental health needs, developed treatment plans and monitored progress.
- Collaborated with multidisciplinary teams to develop and deliver treatment plans and patient care.
- Utilized evidence-based techniques to deliver successful treatment.
- Maintained client confidentiality to protect patient privacy.
- Developed treatment plans to outline steps necessary for clients to achieve goals.
- Improved clients'' daily living skills by providing guidance in areas such as personal hygiene, communication, and social interactions.
- Conducted crisis intervention as needed to ensure the safety and stability of clients in high-risk situations.
- Enhanced therapy outcomes by implementing evidence-based practices and personalized treatment plans.
- Advocated for clients'' needs within the community, connecting them to appropriate resources and support services.
- Maintained detailed documentation of client sessions, progress notes, and treatment plans for accurate reporting and continuity of care.
- Continually pursued professional development opportunities to enhance therapeutic knowledge base and stay abreast of industry best practices.
- Utilized creative modalities like art, music, or play therapy when appropriate to engage clients in alternative forms of self-expression during sessions.
- Developed and implemented individualized behavior modification plans to reduce challenging behaviors and promote positive change.
- Documented patient information, treatment plans, and patient responses.
- Tracked progress according to goals for interventions.
- Educated clients and families on mental health issues to promote understanding and support.
- Attended continued education sessions to maintain professional standards and stay up-to-date with new developments.
- Worked with interdisciplinary treatment team to develop treatment plans.
Education
Bachelor of Science - Psychology
Clarion University of Pennsylvania
Clarion, PA01.1992
Skills
- Interpersonal skills
- Quality Assurance
- Insurance regulations and requirements
- Claims Processing and management
- Forms development, completion, and filing
- Policy Interpretation
- Time management
- Effective verbal and written communication
- Fraud detection capabilities
- Strategic planning
- Process improvement strategies
- Conflict resolution techniques
- Regulatory compliance
- Project management
- Decision-making proficiency
- Team leadership experience
- Claims auditing
- Claims analysis
- Quality assurance
- Procedure implementation
- Policy interpretation
- Insurance policy requirements
- Teamwork and collaboration
- Attention to detail
- Multitasking
- Critical thinking
- Organizational skills
- Relationship building
- Task prioritization
- Self motivation
- Critical and Analytical thinking
- Conflict resolution
- Recruitment and hiring
- Staff management
- Adaptability
- Verbal and written communication
- Project management
- Process implementation
- Workflow coordination
- Data analysis
Accomplishments
- Supervised and scheduled team of 40 staff members.
- Collaborated with team of four in the development of the Stepping Stones camp and social programs
- Achieved positive quality results by conducting and assisting in audits to ensure compliance and accuracy, which resulted in no retracted payments
- Documented and resolved in which led to [Results].
- Achieved aeffective through effectively helping with [Task].
Timeline
Long Term Disability Senior Claims Manager II
New York Life Insurance Company
10.2022 - Current
Intake Service Coordinator
The Watson Institute
12.2016 - 03.2021
Assistant Wraparound Coordinator
The Watson Institute
09.2005 - 12.2017
Therapeutic Support Staff
The Watson Institute
09.2005 - 12.2007
Therapeutic Support Staff
Northwestern Human Services
09.2000 - 09.2005
Bachelor of Science - Psychology
Clarion University of Pennsylvania
Achievement Award, The Watson Institute, 2009
Awarded achievement award for the 2009 year for exceptional working skills and team collaboration.
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