Kathryn Roberts
Gibsonia
Summary
Healthcare professional with over 20 years of experience enhancing patient independence through individualized care, rehabilitation programs, discharge planning, case management and multidisciplinary collaboration. Skilled communicator with strong interpersonal, verbal and written skills, team player, adaptable to changing healthcare needs. Committed to contributing to a progressive organization with a commitment to patient-centered care.
Overview
35
35
years of professional experience
Work History
Clinical Review Care Coordinator
Optum (UnitedHealth Group)
01.2022 - Current
- Clinical Review Care Coordinator responsible for managing authorization requests for home health services in accordance with CMS guidelines and nationally recognized standards
- As part of the Home and Community Care Transition team, reviews clinical documentation from home health providers (OT, PT, SLP, Skilled Nursing) to evaluate medical necessity and proper utilization management using internally developed clinical criteria
- Collaborates with Medical Directors, clinical and care management staff to determine best course of action based on clinical factors
- Responsible for maintaining HIPAA compliant electronic medical records and applying CMS Chapter 7 guidelines during home health chart reviews while assessing authorization requests
- Communicate with providers to clarify clinical documentation regarding patient status
- Collaborate with intake, home health, appeals/denials teams, and Medical Directors to ensure timely and accurate processing of authorization requests in line with turn around times and quality metrics
- Communicate denials to healthcare providers as directed by Medical Directors
- Review departmental reports on key quality metrics and identify opportunities for process improvement
- Participate in cross-training initiatives and maintain knowledge of multiple contracts/clients to support business coverage needs
Occupational Therapist
St. Barnabas Health System
01.2012 - 12.2022
Occupational Therapist
HealthSouth Rehabilitation Hospital of Sewickley
01.2012 - 12.2018
Occupational Therapist
HCR ManorCare
01.2013 - 12.2014
Occupational Therapist
REHABWORKS, Inc.
01.2000 - 12.2005
Occupational Therapist
National Rehab, Inc.
01.2000 - 12.2005
Occupational Therapist
West Penn Rehabilitation Services
01.2000 - 12.2005
- Occupational Therapist provides direct clinical care in hospitals, skilled nursing facilities and home health care collaborating with a multidisciplinary team treating adult and geriatric patients with diagnoses including neurological disorders, cardiac and respiratory conditions, traumatic brain injuries, orthopedic and spinal cord injuries
- Performs patient evaluation, develops plan of care, therapeutic interventions and discharge planning
- Supervision of certified occupational therapy assistants, teaching and mentoring students as well training other healthcare professionals on best patient care
- Responsible for maintaining HIPAA compliant electronic medical records, clinical chart reviews, assigns appropriate ICD-10 codes and billing using multiple EMR platforms, performs chart audits
- Maintains accurate and concise patient records in compliance with hospital, agency standards, CMS regulations
Child Protective Service Worker
WV Department of Health and Human Resources
01.1992 - 12.1994
Care Coordinator
Scott's Run Settlement House
01.1992 - 12.1993
Case Manager
Florence Crittenton Outreach
01.1990 - 12.1992
Education
M.S. - Occupational Therapy
Towson University
Towson, MD01.1999
B.A. - Psychology
SUNY Oswego
Oswego, NY01.1990
Skills
- Proficient in medical terminology, anatomy and physiology
- ICD-10 Coding
- Medical Documentation
- CMS guidelines
- Multiple EMR platforms
- Microsoft Office Suite
Certifications Education
- Certified Professional Coder-Apprentice, American Academy of Professional Coders, 01/01/21
- M.S., Occupational Therapy, Towson University, Towson, MD, 05/01/99
- B.A., Psychology, SUNY Oswego, Oswego, NY, 05/01/90
Other Professional Experience
- Occupational Therapy Rehab Technician, HealthSouth Mountainview Regional Rehabilitation Hospital, Morgantown, WV, 01/01/96 - 01/01/99
- Child Protective Service Worker, WV Department of Health and Human Resources, Morgantown, WV, 01/01/92 - 01/01/94
- Care Coordinator, Scott's Run Settlement House, Morgantown, WV, 01/01/92 - 01/01/93
- Case Manager, Florence Crittenton Outreach, Morgantown, WV, 01/01/90 - 01/01/92
Timeline
Clinical Review Care Coordinator
Optum (UnitedHealth Group)
01.2022 - Current
Occupational Therapist
HCR ManorCare
01.2013 - 12.2014
Occupational Therapist
St. Barnabas Health System
01.2012 - 12.2022
Occupational Therapist
HealthSouth Rehabilitation Hospital of Sewickley
01.2012 - 12.2018
Occupational Therapist
REHABWORKS, Inc.
01.2000 - 12.2005
Occupational Therapist
National Rehab, Inc.
01.2000 - 12.2005
Occupational Therapist
West Penn Rehabilitation Services
01.2000 - 12.2005
Child Protective Service Worker
WV Department of Health and Human Resources
01.1992 - 12.1994
Care Coordinator
Scott's Run Settlement House
01.1992 - 12.1993
Case Manager
Florence Crittenton Outreach
01.1990 - 12.1992
B.A. - Psychology
SUNY Oswego
M.S. - Occupational Therapy
Towson University
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