Heather Cantrell
Garden Grove,CA
Summary
Hands-on professional proudly offering more than 8 years of expertise in utilization review and the mental health/substance abuse field. Well experienced in obtaining authorizations, submitting appeals, retro reviews, and medical records. Expert knowledge in insurance criteria, ICD-10, and EMR systems.
Overview
7
7
years of professional experience
Work History
Utilization Review Supervisor
NonPareil Heath Group
01.2023 - Current
- UR Supervisor
- Authorizations for mental health and substance abuse
- Conduct concurrent reviews
- Conduct initial authorizations
- Conduct peer reviews
- Medical records
- Appeals
- Performed prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Monitored workflow to improve employee time management and increase productivity.
- Evaluated employee performance and coached and trained to improve weak areas.
Utilization Review Supervisor
Prosperity Behavioral Health
01.2022 - 01.2023
- Performed prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Supervised and maintained all utilization review documentation through EMR systems.
- Facilitated trainings
Utilization Review Lead
Verity Billing
05.2021 - 01.2022
- Acquire authorization for all levels of care.
- Schedule peer reviews if needed.
- Schedule and complete reviews.
- Medical records.
Lead Utilization Review Specialist
Statim LLC
12.2016 - 01.2021
- Advanced knowledge in Kipu, Lightening Step, Alleva, and Best Notes. 12617 Cleardale Circle Stanton, CA
- Call insurance companies to receive authorization for substance
- Fluent with ICD-10, CPT and REV codes abuse services.
- Verify insurance benefits.
Education
Certification - Substance Abuse/Mental Health Counseling
CAARR Institute
02.2015
Skills
- CPT Coding
- ICD-10
- Medical Billing
- Utilization Management
- Mental Health Counseling
- Crisis Intervention
- Addiction Counseling
- Case Management
- Group Therapy
- Behavioral Health
- Intake Experience
- EMR Systems
- Cognitive Behavioral Therapy
- Crisis Management
- Claims
- Prior authorization
- Management
- Utilization Review
- HIPAA Compliance
- Time Management
- Team Leadership
- Clinical Knowledge
- Ethical Conduct
- Staff Training
- Software Proficiency
- Organizational Skills
- Medical Coding
- Documentation and Reporting
- Clinical Documentation
- 12-Step Program Knowledge
- Continuing Care Planning
- Relapse Prevention
- Medication-Assisted Treatment
- Co-occurring Disorders
- Substance Detoxification
- CPT Coding Knowledge
- ICD-10 Proficiency
- Insurance Verification Abilities
Timeline
Utilization Review Supervisor
NonPareil Heath Group
01.2023 - Current
Utilization Review Supervisor
Prosperity Behavioral Health
01.2022 - 01.2023
Utilization Review Lead
Verity Billing
05.2021 - 01.2022
Lead Utilization Review Specialist
Statim LLC
12.2016 - 01.2021
Certification - Substance Abuse/Mental Health Counseling
CAARR Institute
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