Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Essence Reeves

Richmond,VA

Summary

Seasoned Utilization Review with experience in mental health and substance abuse with expertise in pre-authorization processing and insurance verification. Proven ability to enhance patient care through effective communication and collaboration with providers and insurance companies. Skilled in CPT coding and adept at managing complex cases, ensuring compliance and timely approvals.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Utilization Review Coordinator

Prosperity Behavioral Health
09.2023 - 07.2025
  • Managed multiple mental health and substance abuse facilities at once, obtaining authorization for PHP, IOP, OP, RTC, and detox.
  • Reviewed and communicated the URs with CMs and insurance companies to obtain authorization.
  • Managed peer-to-peer reviews, denials, approvals, appeals, concurrent reviews, extensions, and new pre-certs.
  • Reviewed and processed pre-authorization requests for medical procedures, ensuring compliance with insurance guidelines.
  • Verified patient eligibility and benefits coverage to determine if pre-authorization was required.
  • Collaborated with healthcare providers to obtain necessary documentation and clinical information for pre-authorization requests.
  • Communicated with insurance companies to follow up on pending or denied pre-authorization requests.
  • Ensured timely submission of complete and accurate pre-authorization requests to minimize delays in patient care.
  • Collaborated with the billing department to ensure proper coding and billing practices for authorized procedures.
  • Reviewed clinical documentation for accuracy and adherence to guidelines.

Clinical Administrative Coordinator

UNITED HEALTHCARE
09.2020 - 09.2023
  • Helps support the UM team by setting up authorization requests.
  • Very knowledgeable with the DMAS forms.
  • Receives phone calls from members and providers.
  • Daily interaction with providers and members.
  • Participates in special projects, completes everyday tasks given by UM Team, Care Coordinators, and supervisor.
  • I work in programs such as Community Care, ICUE, Cisco, Medicaid Portal, Omega, Teams, Webex, and OneNote.
  • Knowledgeable in Medicaid CPT codes.
  • Back up team lead for authorization team.

Wellness Coordinator

ADVANCED WELLNESS CENTER
06.2019 - 09.2020
  • Primary duties include validating insurance eligibility, scheduling, and responding to multiple busy line telephones.
  • Additionally handling marketing and social media posting.
  • Also responsible for medical billing, veteran authorizations, and promoting health and wellness throughout the company.
  • Other duties include daily opening and closing deposits and any other assigned administrative tasks.
  • Performs recurring work assignments and participates in special projects.

Education

BACHELOR OF SCIENCE -

RADFORD UNIVERSITY
01.2018

Skills

  • Alleva, Kipu, Best Notes, Avea
  • Insurance portals
  • Excel
  • CPT coding
  • Utilization management
  • ICD-10
  • Microsoft Excel
  • Medical billing
  • Medical terminology
  • Pre-authorization processing
  • Insurance verification
  • Clinical documentation review

Certification

  • AAPC Medical coding

Timeline

Utilization Review Coordinator

Prosperity Behavioral Health
09.2023 - 07.2025

Clinical Administrative Coordinator

UNITED HEALTHCARE
09.2020 - 09.2023

Wellness Coordinator

ADVANCED WELLNESS CENTER
06.2019 - 09.2020

BACHELOR OF SCIENCE -

RADFORD UNIVERSITY

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