Monique Taylor
Columbus
Summary
Healthcare Professional with proven to deliver exemplary level of healthcare service delivery to patients. Coordinate admission and discharge of patients. Plan and implement strategies for developing improved health care management. Proven problem solver and excellent communicator. Strong organizational skills, superb understanding of data collection and performance metrics. Recognized for staff development leading to high performing teams.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Care Navigator
Curative
12.2024 - Current
- Identified potential barriers to care, implementing tailored solutions to improve outcomes.
- Provided emotional support to patients and families during difficult times, fostering trust and rapport within the therapeutic relationship.
- Demonstrated adaptability when faced with sudden changes in patient needs or organizational policies, ensuring a seamless continuation of care navigation services.
- Enhanced patient satisfaction by providing comprehensive care coordination and support.
- Educated patients and families on available resources, empowering them to make informed decisions about their care.
- Promoted a positive work environment among peers by remaining approachable, supportive, and flexible when collaborating on shared tasks.
- Maintained confidential health information according to state and federal regulations.
- Consistently maintained confidentiality while handling sensitive patient information in accordance with HIPAA guidelines.
- Maintained detailed documentation of patient interactions, treatment plans, and progress notes for accurate recordkeeping.
- Assisted patients in scheduling doctor and healthcare appointments.
- Educated patients on insurance and healthcare plans.
- Participated in regular team meetings, huddles, staff meetings and quality improvement projects to improve patient care.
- Verified patient insurance eligibility and entered patient information into system.
- Answered incoming calls, scheduled appointments and filed medical records.
- Provided excellent customer service to patients and medical staff.
- Resolved customer complaints using established follow-up procedures.
- Facilitated communication between patients and various departments and staff.
Care Management Coordinator, Ohio Rise
Aetna, A CVS Health
05.2022 - 12.2024
- Scheduled appointments and conducted follow-up calls to clients.
- Responded to emails and other correspondence to facilitate communication and enhance business processes.
- Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
- Arranged transportation and documented details of discharge transition plans.
- Created and updated records and files to maintain document compliance.
- Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
- Communicated with patients and family members to assist with information, provide literature and direct to community resources.
- Worked with insurance carriers to obtain authorization approvals for medications, supplies and equipment.
- Coordinated post-discharge care by communicating with outpatient clinics, community resources, agencies and families around patients' transitional care.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Communicated with patients, ensuring that medical information was kept private.
- Helped clients develop new coping mechanisms and techniques to drive behavior modification.
- Facilitated family therapy sessions between children, caregivers, and siblings to remediate conflict and build healthy relationships.
- Intervened in crisis situations and counseled children experiencing emergencies and disruptive incidents.
- Facilitated family meetings to ensure communication and collaboration between family members.
- Assisted families in navigating the social services system, including applying for benefits, accessing resources and connecting with other family support services.
- Documented data and completed accurate updates to case records.
- Completed comprehensive assessments of families to identify needs and develop treatment plans.
- Built solid and trusting rapport with children and families, fostering trust and communication to meet case needs.
- Collaborated with school personnel, parents and mental health providers to maintain comprehensive and integrated approach to student services.
- Arranged medical and psychiatric tests to identify difficulties and indicate potential remedial approaches.
Home Health Billing Specialist
ECS Solutions
02.2020 - 09.2022
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Generated and submitted invoices based upon established accounts receivable schedules and terms.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Identified payment trends and adjusted billing processes accordingly to retain customers.
- Monitored customer accounts to identify and rectify billing issues.
- Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
- Researched and resolved billing discrepancies to enable accurate billing.
- Provided excellent customer service, developing and maintaining client relationships.
- Prepared and submitted monthly billing reports to management for financial overview.
- Reviewed and reconciled customer accounts to manage accuracy of payments.
- Responded to customer concerns and questions on daily basis.
- Collaborated with customers to resolve disputes.
- Audited and corrected billing and posting documents for accuracy.
- Utilized various software programs to process customer payments.
Billing Coordinator
Caresource at Home Hilliard, OH
01.2016 - 01.2020
- Accurately enter patient billing data, including visit charges and supply charges, into the information system
- Alert appropriate management team members regarding late or missing documents required for billing
- Accurately process and bill Medicare, Medicaid, private payer and patient claims, make corrections and resubmit claims as necessary
- Communicate and interact with external customers about claims questions, maintain accurate systems for tracking productivity, post payments received to accounts, scan documents for filing
- Conduct a billing audit process to ensure compliance with all regulations prior to submission of billing
- Retrieve Claim Acknowledgement Reports and resolve all issues in a timely manner
- Retrieve Remittance Advices and post to CareSource@Home when confirmation of deposit is received
- Resolve all denied and unpaid claims from Remittance Advices in a timely manner
- Monitor for Medicare Additional Development Requests (ADR), and alerts appropriate management of ADR
- Generate Accounts Receivable reports on a weekly basis, and account for all outstanding claims in writing
- Generate Unbilled/ Unbillable Activity Reports on a weekly basis and follow- up with agency personnel as required to resolve unbilled and unbillable reasons
- Maintain billing and patient accounts record files in accordance with generally accepted accounting principles and in compliance with local, state, and federal laws
- Follow company policies and procedures and maintains strict HIPPA compliance
- Various bookkeeping and administrative duties as assigned
- Aetna Better Health of Ohio New Albany, OH
Care Management Coordinator
01.2015 - 01.2016
- Conduct comprehensive evaluation of member's needs/eligibility
- Review authorizations, review units for appropriate billing for Services
- Review claims for appropriate billing compared to authorizations
- Coordinate for nursing home placement, skilled and unskilled
- Manage caseload for the Medicare/Medicaid dual population
- Conduct face to face visits with members
- Evaluating members benefit plan and available internal and external programs/services
- Identifies high risk factors and service needs that may impact member outcomes
- Coordinate and implement assigned care plan activities and monitors care plan progress
- Utilize negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs
- Utilize motivational interviewing skills to ensure maximum member engagement and promote healthy lifestyle/behavior
- Provide coaching, information and support to empower member's independence
- Perform routine comprehensive, independent reassessment of patient status and progress toward achievement of care plan goals
- Maintain accurate, up-to-date documentation in the established case management record system
- Special Projects: worked in the Grievance and Appeals department for approximately four months to resolve past due grievances, worked in the Quality Management department for approximately four months helping with various projects including provider clean up, waiver service audits and other various tasks.
Care Management Associate
Aetna Better Health of Ohio New Albany, OH
01.2014 - 01.2015
- Completed competent interviews, accessed resources to gather information for factual based on which to formulate a plan
- Provide direction to members on authorizations, services, triaged to appropriate departments
- Oversee daily operations of an inbound call center team and worked closely with the department management team
- Critically analyzed information gathered during assessment phase and applied in the formulation of a plan
- Established patient goals based on appropriate resource utilization, patient consensus, and level of care and services required
- Conveyed knowledge of health and/or social service delivery model to patients
- Demonstrated knowledge and understanding of patient's health and social presenting risks and applied appropriate risk stratification
- Effectively utilized existing community resources in providing care/services to meet goals.
Lab Manager
Columbus Sleep Consultants Columbus, OH
01.2008 - 01.2014
- Monitored referrals, taking appropriate actions to resolve issues that patients may encounter in a timely manner
- Reconciled billing to remittance advice
- Responsible for all billing and collaborated with finance and billing department for prompt remittances to vendors
- Contributed to all mask and equipment exchange program goals and objectives in containing sleep lab care cost and maintaining a high quality system through the program procedures and conducting quality assurance
- Recommended and coordinated management of medical cost through timely prospective, concurrent and retrospective review activities
- Communicated directly with physician providers, when appropriate to gather all clinical information to determine the medical necessity of requested health services
- Served as a liaison for provider staff, sleep techs and patients
Education
MBA - Healthcare Concentration
Strayer University
Washington, DC06.2025
Bachelor of Arts - Psychology
Otterbein University
Westerville, OH06.2002
Skills
- Project Management
- Psychosocial Assessments
- Case Management
- Billing for MC, MD, Pvt
- Insurance
- Data Entry/Research
- Analytical Analysis
- Grievance & Appeals
- Customer Service Skills
- Quality Management
- Microsoft Office Suite
- Interviewing
- Medicare/Medicaid/Duals Communication Skills
- Multidisciplinary Team Collaboration
- Direct Patient Care
- Payment Processing
- Accurate Recordkeeping
- Office Operations
- CMS Guidelines
- Patient Care Management
- Care Monitoring
- Insurance Authorizations
- Resource Monitoring
- Patient Referral
- Facility Inspections
- Patient Interviews
- Utilization Management
- Clinical Quality Program Standards
- Emergency Readiness
- Scheduling Tests and Procedures
- Adaptable and Flexible
- Medical Records Verification
- Information Assistance
- Patient Eligibility Requirements
- Administrative Staff Supervision
- Recruit Well-Qualified Staff
- Clerical Support
- Medical Report Preparation
- Electronic Medical Record Software
- Problem Identification
- Customer Experience
- Quality Management Processes
- Computer Proficiency
- Train Employees
- Patient Health Information Access
- HIPAA Guidelines
- EHR Software
Certification
- Certified CANS assessor
Additional Information
Certified in Mental Health First Aid
Timeline
Care Navigator
Curative
12.2024 - Current
Care Management Coordinator, Ohio Rise
Aetna, A CVS Health
05.2022 - 12.2024
Home Health Billing Specialist
ECS Solutions
02.2020 - 09.2022
Billing Coordinator
Caresource at Home Hilliard, OH
01.2016 - 01.2020
Care Management Coordinator
01.2015 - 01.2016
Care Management Associate
Aetna Better Health of Ohio New Albany, OH
01.2014 - 01.2015
Lab Manager
Columbus Sleep Consultants Columbus, OH
01.2008 - 01.2014
MBA - Healthcare Concentration
Strayer University
Bachelor of Arts - Psychology
Otterbein University
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