Amy Shafiee
West Valley City
Summary
Dedicated and accomplished professional with six years of experience in the behavioral health field, including four years specializing in admissions. Adept at managing the complexities of the admissions process, I have consistently demonstrated a commitment to providing compassionate support to individuals seeking behavioral health services. Skilled in assessing client needs, coordinating admissions procedures, and ensuring compliance with regulatory requirements. Known for fostering positive relationships with clients, families, and interdisciplinary teams. Seeking to bring my expertise to a dynamic behavioral health organization, where I can contribute to the well-being of individuals and support the growth of the team
Overview
6
6
years of professional experience
Work History
Utilization Review Specialist
Billing Solutions LLC
09.2023 - Current
- Evaluate and assess the appropriateness of proposed or ongoing treatment plans for individuals with behavioral health needs.
- Conduct thorough utilization reviews to determine the medical necessity and efficiency of provided behavioral health services.
- Ensure that all documentation related to utilization review is accurate, complete, and compliant with regulatory standards and organizational policies.
- Collaborate with healthcare providers to gather additional information, clarify treatment plans, and address any concerns related to the utilization review process.
- Work closely with other healthcare professionals, including psychiatrists, therapists, and case managers, to coordinate and optimize the delivery of behavioral health services.
- Stay informed about and adhere to federal and state regulations, as well as industry standards, related to behavioral health services and utilization review.
- Stay current on clinical criteria and guidelines for behavioral health treatment to make informed decisions during the utilization review process.
- Prepare and submit comprehensive prior authorization requests to insurance companies, including all necessary clinical documentation and treatment justifications.
- Knowledge of the ASAM/LOCUS criteria.
Admissions Specialist
The OCD & Anxiety Treatment Center
06.2022 - 09.2023
- Collaborates with internal teams to understand TOATC services and effectively communicates program features and benefits to potential and existing clients.
- Maintains and grows existing client relationships by learning and following admissions skills.
- Responds to all inquiries knowledgeably, with empathy within 24 hours.
- Schedules prospective clients with therapists for intake appointments.
- Follows up with prospective clients to maintain stage conversion rates and reschedule canceled appointments.
- Enters data accurately into CRM and other platforms before end of work day
- Helps navigate barriers for clients and assist them into TOATC programs.
- Adheres to all company policies and procedures.
- Trained new hires on all policies and procedures in Admissions.
- Provide clients with insurance information and explain coverage.
- Collect payments towards insurance or self pay rates.
Admissions Coordinator
The Phoenix Recovery Center
09.2019 - 06.2022
- Confirmed all insurance benefits met standards of admissions as dictated by policy.
- Managed admissions processes for incoming clients, promptly collecting and processing necessary documents.
- Collaborated with admissions team to develop and implement strategies to improve admissions process.
- Assisted in patient admission process based on federal and state laws.
- Completed preliminary paperwork for incoming and outgoing patients.
- Reviewed applications/screenings to verify clients eligibility and compliance with admissions criteria.
- Marketing/outreach with other providers.
- Conduct verification of benefits
- Collect payments
- Provide Mental Health screenings
- Pre-authorizations
Peer Support Staff
The Phoenix Recovery Center
06.2018 - 06.2019
- Followed up with customers to verify satisfaction and address outstanding concerns.
- Attended training sessions to stay updated on procedures and services.
- Assist and monitor client's daily activates and maintain client information and progress.
- Medication Dispensing
- Report and document client behavior
Certified Case Manager
Valley Behavioral Health
11.2017 - 06.2018
- Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
- Monitored clients' progress and tracked client services to provide crisis interventions.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Developed comprehensive discharge plans to transition clients to appropriate service providers in community.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
- Provided evidence-based therapeutic interventions and crisis management to clients to lessen negative on physical, mental and emotional wellbeing.
- Evaluated treatment plans against individual goals and healthcare standards.
- Facilitated individual and group sessions to promote positive behavior change for clients.
- Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
- Monitored program performance and outcomes for successful delivery of services.
Education
GED -
Granite Peaks Learning Center
Murray, UT06.2011
Skills
- Admissions Process Management
- Assessment and Evaluation
- Insurance Verification
- Client Communication
- Crisis Intervention
- HIPAA Compliance
- Interdisciplinary Collaboration
- Cultural Competence
- Documentation and Record Keeping
- Time Management
- Customer Service
- Problem Solving
- Training and Education
- Level of Care Criteria Knowledge
- Behavioral Health and Healthcare Industry Knowledge
Timeline
Utilization Review Specialist
Billing Solutions LLC
09.2023 - Current
Admissions Specialist
The OCD & Anxiety Treatment Center
06.2022 - 09.2023
Admissions Coordinator
The Phoenix Recovery Center
09.2019 - 06.2022
Peer Support Staff
The Phoenix Recovery Center
06.2018 - 06.2019
Certified Case Manager
Valley Behavioral Health
11.2017 - 06.2018
GED -
Granite Peaks Learning Center
Similar Profiles
Justin DavidsonJustin Davidson
Billing Specialist at Billing Solutions LLC.Billing Specialist at Billing Solutions LLC.
Brittany IngramBrittany Ingram
Owner, Billing and Credentialing Specialist at Independent Billing Solutions, LLCOwner, Billing and Credentialing Specialist at Independent Billing Solutions, LLC
Kenya BryanKenya Bryan
Claims Review Specialist II (Remote) at Conifer Health SolutionsClaims Review Specialist II (Remote) at Conifer Health Solutions