Amber Mills
Charlotte,NC
Summary
Seasoned Utilization Management Specialist with a proven track record at Advent Health Shawnee Mission, enhancing care coordination and resource optimization. Experienced in medical coding and adept at fostering communication, I significantly improved turnaround times. Skilled in HIPAA compliance and utilization review, my multidisciplinary approach consistently achieves superior patient care outcomes.
Overview
7
7
years of professional experience
Work History
Utilization Management Specialist
Advent Health Shawnee Mission
Shawnee Mission, KS
01.2024 - Current
- Facilitated communication between clinicians, payers, and health plan administrators.
- Educated healthcare providers on utilization review processes, criteria, and best practices.
- Participated in multidisciplinary team meetings to discuss patient care issues and utilization review findings.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
- Documented all utilization review activities, findings, and decisions in patient records and databases.
- Monitored patient admissions and discharges to optimize care coordination and resource utilization.
- Maintained accurate documentation of all utilization management activities.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
Authorizations Specialist/ Surgery Scheduler
Piedmont Plastic Surgery and Dermatology
Gastonia , NC
02.2023 - 01.2024
- Distributed treatment and procedural information to patients.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Attended weekly meetings with department managers in order to review progress of surgical scheduling operations.
- Assisted with pre-operative preparation such as obtaining insurance authorizations, lab work, radiology tests.
- Monitored and updated patient records in the electronic medical record system.
- Reviewed patient records and assigned accurate codes for diagnoses and procedures.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Developed a thorough understanding of CPT and HCPCS codes and modifiers used in the healthcare industry.
- Analyzed payer contracts for reimbursement requirements related to coding guidelines.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Collaborated with healthcare providers to verify necessary documentation for coding accuracy.
Registrar
Atrium Healthcare
Charlotte, NC
02.2018 - 01.2023
- Worked with cross-functional teams to achieve goals (Utilization Management).
- Collaborated with medical staff to obtain necessary documentation for authorizations.
- Implemented new initiatives, which resulted in quicker payments and better turnaround times.
- Maintained confidentiality of all patient related information at all times.
- Extracted ICD-10-CM codes from medical records for authorization submissions.
- Completed referral requests.
Education
Some College (No Degree) - English Education
Central Piedmont Community College
Charlotte, NCSkills
- HIPAA compliance
- Resource optimization
- Insurance verification
- Medical coding
- Records analysis
- Communication
- Utilization management
- Prior authorization
- CPT coding
- Outpatient surgery coding
Timeline
Utilization Management Specialist
Advent Health Shawnee Mission
01.2024 - Current
Authorizations Specialist/ Surgery Scheduler
Piedmont Plastic Surgery and Dermatology
02.2023 - 01.2024
Registrar
Atrium Healthcare
02.2018 - 01.2023
Some College (No Degree) - English Education
Central Piedmont Community College
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