Amber Utz
Fenton,MO
Summary
Experienced healthcare professional with expertise in provider data, claims processing, and auditing records. Demonstrated diligence and efficiency throughout several years in related positions. Possesses a strong foundation of healthcare knowledge and maintains a consistent desire for continuous knowledge acquisition.
Overview
9
9
years of professional experience
Work History
Business Analyst II
Centene
St Louis, MO
06.2020 - Current
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Optimized workflow processes to enhance overall productivity and achieve operational excellence.
- Collaborated closely with stakeholders to identify opportunities for process improvements and drive continuous innovation in the organization.
- Supported software development projects by defining clear requirements and effectively communicating them to technical teams.
- Enabled data-driven decision making with advanced analytics tools, generating valuable insights for the organization.
- Boosted customer satisfaction levels by identifying areas of improvement and proposing actionable solutions.
- Drove operational efficiency by automating routine tasks, freeing up staff to focus on more complex issues.
- Analyzed Medicare claims to identify discrepancies and ensure compliance with regulatory standards.
- Conducted detailed contract reviews to ensure compliance with company policies and regulatory standards.
- Configured claims systems to enhance operational efficiency and accuracy.
- Work high priority projects with challenging situations and acted with urgency
- Established relationships with clients and internal departments
- Assisted in auditing provider and practitioner records
Provider Data Specialist - Lead
LUMERIS
MARYLAND HEIGHTS, MO
01.2017 - 02.2020
- Enrolled providers and practitioners into the provider data management system
- Reviewed and verified updates to provider and practitioner records by researching and placing outbound calls to provider offices
- Terminated providers and practitioners from the provider data management system
- Worked high priority projects with challenging situations and acted with urgency
- Established relationships with clients and internal departments
- Wrote detailed reports for leadership outlining discoveries, recommendations and progress with changes
- Interacted with other departments to resolve provider or claims issues
- Handled all PCP matters within 24 hours including enrollment, terminations, updates to demographics and or panel updates
- Sent PCP alerts to notify all departments of PCP updates to ensure members were not impacted
- Resolved claim errors to ensure accurate claims processing
- Assisted in auditing provider and practitioner records
- Trained new hires.
Customer Service Associate
BIG LOTS
FENTON, MO
05.2016 - 01.2018
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Optimized workflow processes to enhance overall productivity and achieve operational excellence.
- Collaborated closely with stakeholders to identify opportunities for process improvements and drive continuous innovation in the organization.
- Supported software development projects by defining clear requirements and effectively communicating them to technical teams.
- Enabled data-driven decision making with advanced analytics tools, generating valuable insights for the organization.
- Boosted customer satisfaction levels by identifying areas of improvement and proposing actionable solutions.
- Drove operational efficiency by automating routine tasks, freeing up staff to focus on more complex issues.
- Analyzed Medicare claims to identify discrepancies and ensure compliance with regulatory standards.
- Conducted detailed contract reviews to ensure compliance with company policies and regulatory standards.
- Configured claims systems to enhance operational efficiency and accuracy.
- Work high priority projects with challenging situations and acted with urgency
- Established relationships with clients and internal departments
- Assisted in auditing provider and practitioner records
Education
High School Diploma -
Northwest High School
Cedar Hill, MO05.2010
Skills
- Medical terminology
- Healthcare Knowledge
- Data verification and entry
- Relationship management
- Staff training and motivation
- Claims resolution
- Provider types and specialties
- Critical thinking
- Excel Analytics
- Reporting analysis
- CMS knowledge
- Contract Review
- Billing knowledge
Accomplishments
Employee of the month in several roles
Timeline
Business Analyst II
Centene
06.2020 - Current
Provider Data Specialist - Lead
LUMERIS
01.2017 - 02.2020
Customer Service Associate
BIG LOTS
05.2016 - 01.2018
High School Diploma -
Northwest High School