Heather Blizzard
Ocean View,NJ
Summary
Analytical, results-oriented, and multifaceted professional, with hands-on experience in utilization review and case management. Demonstrate effectiveness in supporting clinical review operations by evaluating process efficiency and appropriateness of medical services, procedures, and facilities in compliance with regulatory bodies. Exemplify strong critical thinking and problem-solving skills in resolving conflicts, while maintaining confidentiality of all information. Leverage ability in collaborating with interdisciplinary healthcare teams to ensure delivery of quality care to patient from admission to discharge phases.
Experienced with utilization management, ensuring optimal use of healthcare resources and compliance with regulations. Utilizes strong analytical skills and collaborative approaches to streamline processes and enhance patient care. Knowledge of industry standards and best practices, coupled with effective leadership and communication abilities.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Utilization Review Manager/ Billing/ Account Receivable
Discovery Institute for Addictive Disorders
01.2016 - Current
- Perform and bill Prospective, Concurrent and Retrospective Utilization Review to verify medical necessity of self-funded union clients
- Led and trained a small team benefits representatives on behavioral health substance benefits.
- Process incoming provider applications and maintain existing contract and credentialing documents to ensure records and documents are complete, accurate and compliant with regulatory agencies.
- Oversee outside billing company with Utilization Review and revenue management.
- Continues to develop, monitor, and improve realistic admissions, LOC norms and discharge criteria.
- Encourages and maintains Institute-wide participation in an ongoing peer review process.
- Promotes the use of quality improvement data in the evaluation of all members of the Professional Staff.
- Review medical records for accuracy, quality assurance, billing, and insurance purposes.
- Work alongside marketing and admissions to admit clients in a timely manner.
- Provide training for staff regarding utilization reviews, peer reviews, medical records charts for Joint Commission.
- Leads and oversees the implementation of all provider contracts, including pertinent changes and modifications applicable to these contracts
- Perform follow up with Commercial insurance companies on unpaid insurance claims identified through aging reports and pending physician reports.
- Collaborated with clinical team to enhance documentation for dual diagnosis treatments to decrease denials.
Utilization Review Manager
Park Bench Group Counseling
01.2009 - 01.2016
- Organized various utilization review activities to all levels of behavioral health care, partial hospitalization intensive outpatient and outpatient authorization requests with contacts to facilities and providers as needed to accomplish task.
- Conducted face-to-face assessments for all levels of care, while obtaining clinical information for concurrent reviews with strict compliance with the American Society of Addiction Medicine (ASAM) procedures.
- Ensured the delivery of quality service and effective discharge planning for optimal member health results.
- Demonstrated competency in dealing with diverse circumstances ranging from crisis intervention to routine business matters.
- Collaborated with Treatment Team in developing treatment and prevention plans required in the utilization review process.
- Delivered presentation of clinical cases to staff and consulting providers as requested by the supervisor and aligned with policies and procedures.
- Accomplished proper documentation in clinical systems in compliance with regulatory and accreditation guidelines.
- Managed all consultations on clinical cases with member’s provider, family, and physician consultants when necessary to provide care and coordinate progress.
- Observed strict adherence to all policies and procedures for utilization management activities such as screening and referral activities, which included timeliness and accuracy of documentation.
- Earned distinction as the recipient of 2013 Employee of the Year award for driving revenue increase by 20%.
- Provided strategic recommendations of programs and systems, which drove positive results and timeliness improvement in the Utilization Management Department.
Case Manager
01.2009 - 01.2012
- Provided expert supervision of all needs and work in coordination with client and individual therapists to create treatment planning and goals; as well as to determine additional support services such as educational, vocational, legal, recreational, mental health, and social services.
- Facilitated preliminary introduction and initial consultation for all detox and residential clients as well as orientation to new clients on programming and rules.
- Developed an aftercare plan upon admission by coordinating with client and individual therapist, while facilitating group therapy in accordance with the program schedule.
- Provide effectual assistance in recognizing resources and facilitating suitable services for referral, in conjunction with the Clinical Team.
- Maintained communication with parents and other approved family members to encourage and facilitate family participation and education.
- Assumed full responsibility in informing family members of aftercare planning and scheduled changes in care levels.
- Carried out documentation of delivered services including individual records, progress notes, group notes, and aftercare plans.
- Ensured accuracy of services documented within the medical and clinical charts and supports, while rendering support in the compliance with facility and licensing principles.
- Cooperated with members of the multi-disciplinary treatment team to ensure effective delivery of full-spectrum clinical services.
Education
Bachelor of Arts -
Rowan University
Glassboro, NJSkills
- Microsoft Office Suite (Word, Excel, and PowerPoint) Salesforce, KIPU, SharePoint, Teams
- HIPAA compliance
- Healthcare regulations
- Utilization management
- Medical coding
Certification
- Certified Alcohol and Drug Counselor (CADC) Candidate
- AAPC Training- Certified Professional Biller coursework
Timeline
Utilization Review Manager/ Billing/ Account Receivable
Discovery Institute for Addictive Disorders
01.2016 - Current
Utilization Review Manager
Park Bench Group Counseling
01.2009 - 01.2016
Case Manager
01.2009 - 01.2012
Bachelor of Arts -
Rowan University
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