Brandi Torres
Arnold,MO
Summary
Dependable Utilization Management Representative with extensive experience in prior-authorizations, excelling in HIPAA compliance and claims management. Proven ability to handle high call and fax volumes while maintaining professionalism and accuracy. Strong understanding of medical terminology and insurance eligibility verification, ensuring optimal service delivery and client satisfaction.
Overview
24
24
years of professional experience
Work History
Utilization Management Representative II
Elevance Health, Inc.
02.2007 - 03.2025
- Performed prior authorization review and approval of services requested for Behavioral Health by phone and fax.
- Verified benefits for Commercial, Medicare and Medicaid.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Met customer call guidelines and metrics for service levels, handle time, productivity and accuracy.
- Completed high volume of incoming fax requests meeting all department metrics.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Assisted clinical staff and fielded emergency calls as needed.
Utilization Management Representative I
Anthem / Wellpoint Companies, Inc.
01.2001 - 02.2007
- Processed medical requests for in-patient and out-patient procedures and admissions.
- Managed high call volume while maintaining accuracy and professionalism in documentation of interactions with customers.
- Verified patient insurance coverage and benefits for medical claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Education
No Degree
Southwestern Illinois College
Belleville, ILSkills
- Effective time management
- HIPAA compliance
- Professionalism and ethics
- Claims management
- Knowledge of healthcare regulations
- Insurance eligibility verification
- Strong understanding of medical terminology
- CRM software
Timeline
Utilization Management Representative II
Elevance Health, Inc.
02.2007 - 03.2025
Utilization Management Representative I
Anthem / Wellpoint Companies, Inc.
01.2001 - 02.2007
No Degree
Southwestern Illinois College
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