Beblys Castillo
Virginia Beach,VA
Summary
Dynamic Utilization Management Representative III at Elevance Health with a proven track record in optimizing healthcare service delivery. Expert in data analysis and HIPAA compliance, I enhance operational efficiency while fostering teamwork and effective communication. Successfully reduced wait times for essential services through streamlined authorization processes, ensuring timely patient care and adherence to industry standards.
Overview
21
21
years of professional experience
Work History
Utilization Management Representative III
Elevance Health
Virginia Beach, VA
01.2005 - Current
- Analyzed utilization review processes to ensure compliance with healthcare regulations.
- Coordinated communication between healthcare providers and insurance teams for timely decisions.
- Reviewed clinical documentation for accuracy, ensuring appropriate care levels were authorized.
- Supported training initiatives for new team members on utilization management protocols and systems.
- Monitored and reported on key performance indicators related to authorization workflows.
- Conducted thorough reviews of medical records, ensuring compliance with regulatory requirements and industry standards.
- Optimized the delivery of healthcare services by staying current on emerging trends and developments in the field of utilization management.
- Reduced wait times for essential services by effectively managing utilization review caseloads and prioritizing urgent requests.
- Maintained up-to-date knowledge on relevant health policies, regulations, and industry best practices through ongoing professional development opportunities.
- Served as a liaison between patients, healthcare providers, and insurance companies to facilitate timely approvals of necessary treatments.
- Increased overall efficiency by streamlining authorization processes for medical procedures.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Consistently meet productivity, quality and performance standards.
Education
Bachelor of Science - Accounting And Finance
Universidad Nacional Experimental Simón Rodríguez
Venezuela 05.1988
Skills
- Critical thinking
- HIPAA compliance
- Professionalism and ethic
- Insurance verification
- Prior Authorizations Processing
- Data Entry & Documentation
- Medical terminology proficiency
- Documentation and reporting
- Medicaid
- Teamwork
- Multitasking Abilities
- Excellent communication
- Team collaboration
- Active listening
- Effective communication
- Clinical documentation
- Interpersonal skills
- Professionalism
Languages
Spanish
Native or Bilingual
Timeline
Utilization Management Representative III
Elevance Health
01.2005 - Current
Bachelor of Science - Accounting And Finance
Universidad Nacional Experimental Simón Rodríguez