Utilization Management Coordinator Resume Pasadena, CA - Hire IT People

SKILLS:

Microsoft Office Applications, type 45 - 50 wpm

PROFESSIONAL EXPERIENCE:

Confidential, Pasadena, CA

Utilization Management Coordinator

Responsibilities:

Answered incoming calls from ancillary providers, hospitals, and physician offices regarding prior authorization
Manage appropriate patient data
Request clinical records per procedure
Apply appropriate polices, procedures, and eligibility and benefit policies
Refer request and notifications to licensed health professional for review
Perform clerical support duties
Document all activities as per policy into automated systems
Issue authorization approval outcomes in compliance with state, federal and accreditation requirements
Authorize specifically designated services, based on company policy, that do not require medical necessity
Maintain confidentiality of all PHI in compliance with state and federl law and Confidential Policy
Accuratley apply appropriate policies, procedures, eligibility and benefit policies
Report suspected fraud and abuse as per company policy

Confidential, Torrance, CA

Benefit Claims TPA Representative

Responsibilities:

Confidential, Woodland Hills, CA

Benefit Configuration Business Analyst

Responsibilities:

Confidential, Pasadena, CA

Healthcare Analyst

Responsibilities:

Educated end-users, and new internal employees on software configuration and front end functionality to ensure proper utilization of the Epic software and ancillary applications
Participated in Client sessions to ensure sessions were tailored to individual need with respect to their specific workflow and procedures
Acted as the liaison between the end user and the deployment consultant Identified key healthcare redesign business issues Reported security issues to national help desk for resolution Entered data collected into an online database for tracking and analysis
Assisted in various medical center Go-Lives throughout So Cal
Entered data into an online database for tracking and analysis
Identified and triaged system problems
Collaborated with other teams leads on special projects

Confidential, Los Angeles, CA

Quality Assurance Specialist

Responsibilities:

Participated in the development and implementation of internal training procedures and programs to meet specific training needs
Developed training material and conducted presentations for new application modules
Conducted training exercises and classes for groups and individuals
Assessed group and individual skill levels to determine appropriate training content
Conducted monthly audits to determine areas of deficiencies in documentation
Collaborated with Departmental managers to ensure accurate and timely presentation of audit findings and issued recommendations for corrective actions
Provided coaching when needed
Monitored, analyzed and evaluated effectiveness of training based on departmental goals

Confidential, Los Angeles, CA

Managed Care Intake Coordinator

Responsibilities:

Served as the initial point of contact for medical groups, hospitals, and providers
Responded to telephone and written inquiries from medical groups and hospitals
Referred cases to clinical team when appropriate
Assisted team members in data entering cases for care coordination
Used established online systems to research and obtain information
Audited medical group mail logs and faxes for completeness
Approved request for services on acute inpatient and outpatient services
Assigned CPT and ICD 9 codes to claims for processing

Confidential, Los Angeles, CA

Member Services Call Center Lead

Responsibilities:

Assisted with complex claims, benefits, and eligibility issues
Evaluated and monitored incoming call abandonment rates
Responded to escalated subscriber and provider phone calls
Adjudicated and researched medical claims for payment
Interfaced with staff from other departments Audited and analyzed team members daily aging reports