Brittany Engrasci-Sykes
Murrieta,CA
Summary
Over 8 years of experience in Utilization Review.
Extensive knowledge of all Level's of Care ( DTX,RTC,PHP, IOP) for Substance abuse. High level of experience in Mental Health RTC - IOP LOC for both adult and adolescents. Extensive knowledge of multiple CRM platforms.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
13
13
years of professional experience
Work History
Utilization Review Specialist
Indigo Billing
Orange, Ca
12.2021 - Current
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Obtained authorizations from multiple insurance carriers for various levels of care.
Utilization Review Assistant Manager
BHS
Costa Mesa, CA
06.2020 - Current
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Devise or identify solutions for irregular requests and issues.
- Facilitated workgroup meetings to find effective solutions to issues.
Utilization Review Specialist
Ava Billing
Costa Mesa , CA
11.2020 - 04.2021
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Supported or performed clinical appeals
Utilization Review Manager
Jackson House
La Mesa , CA
11.2017 - 10.2020
- Created UR department protocols, employee evaluations.
- Successfully completed in- network contracting process with multiple insurance companies.
- Helped to expand the UR department from one location to five over 2 years.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity based upon MNC criteria specifications.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Supervised and maintained all utilization review documentation through Kipu and Bestnotes .
- Created and staffed UR department processes and procedures
- Worked in direct alignment with billing department regarding denials, appeals and claims
- Created VOB platform and ran VOB's when necessary
Utilization Review Spe
Carefoward
Beverly Hills, CA
11.2011 - 08.2015
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed admission reviews based for medical necessity based upon insurance medical necessity criteria specification.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Utilization Review Specialist
Above it All
Lake Arrowhead, CA
11.2011 - 04.2015
- Conducting pre-authorization and concurrent reviews throughout the duration of patient's treatment stay
- Consulted with various members of the multidisciplinary treatment team concerning required information to complete concurrent reviews
- Scheduled peer to peer reviews and coordinates urgent/expedited appeals
- Date entry, records management and assisting with the appeals process
- Completed chart audits for medical necessity criteria
Education
Bachelor of Science (B.S - Business Administration
Walden University
Minneapolis, MN08.2016
Skills
- Employee Training Program
- Decision Making
- Time Management
- Expenditure Authorization
- Verbal and Written Communication
- Service Utilization Improvements
Timeline
Utilization Review Specialist
Indigo Billing
12.2021 - Current
Utilization Review Specialist
Ava Billing
11.2020 - 04.2021
Utilization Review Assistant Manager
BHS
06.2020 - Current
Utilization Review Manager
Jackson House
11.2017 - 10.2020
Utilization Review Spe
Carefoward
11.2011 - 08.2015
Utilization Review Specialist
Above it All
11.2011 - 04.2015
Bachelor of Science (B.S - Business Administration
Walden University