Led initiatives to enhance the efficiency of utilization review operations, driving improved resource management.,Oversaw and optimized strategies for comprehensive utilization review, ensuring alignment with organizational goals.,Managed a team to streamline utilization review processes, enhancing overall departmental performance.
Overview
8
8
years of professional experience
Work History
Utilization Review Coordinator
Compass Behavioral Health
Crowley La
06.2025 - Current
Conducted comprehensive reviews of treatment plans for adherence to clinical guidelines and regulatory standards.
Collaborated with multidisciplinary teams to streamline utilization review processes and improve patient care outcomes.
Analyzed data trends in service utilization to identify opportunities for process enhancements and cost reductions.
Led training sessions for staff on documentation requirements and compliance with state and federal regulations.
Oversaw quality assurance initiatives, ensuring accuracy in clinical documentation and decision-making processes.
Enhanced patient care quality by conducting thorough utilization reviews and coordinating with healthcare providers.
Increased efficiency of the utilization review process through regular communication with insurance companies for timely authorizations.
Patient Coordinator
Fielder Family Clinic
Carencro, LA
09.2020 - 08.2023
Maintained high standards of customer service by building relationships with clients.
Finalized sales and collected necessary deposits.
Collected premiums on or before effective date of coverage.
Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
Located errors and promptly refiled rejected claims.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Identified and resolved patient billing and payment issues.
Posted and adjusted payments from insurance companies.
Prepared billing statements for patients and verified correct diagnostic coding.
Collected payments and applied to patient accounts.
Made contact with insurance carriers to discuss policies and individual patient benefits.
Generated, posted and attached information to claim files.
Customer Service Manager
Vautrots Mini Mart
Church Point, LA
08.2018 - 08.2020
Resolved customer complaints while prioritizing customer satisfaction and loyalty.
Trained and regularly mentored associates on performance-oriented strategies and customer service techniques.
Supervised employees and assessed performances to determine training needs and define accurate plans for decreasing process lags.
Followed through with client requests to resolve problems.
Education
High School Diploma -
Church Point High School
Church Point, LA
Skills
Oversaw implementation of insurance practices and streamlined claims processing
Coordinated scheduling efforts to maximize efficiency and productivity
Fostered enduring relationships with clients and stakeholders
Enhanced communication strategies through clear verbal and written exchanges
Leveraged expertise in medical terminology to improve operational effectiveness