Isha Bhatt
Anaheim,CA
Summary
Proactive and Meticulous Utilization Review Manager with over 6 years of experience in Healthcare Industry. With a passion for the healthcare industry, I aim to contribute optimal strategies and operational efficiencies that enhance the experiences of both end user and the organization. Backed by a proven track record in project management, I excel in overseeing individual and team performance, harnessing my strong work ethic to swiftly adapt to diverse workflows and advance corporate goals.
Overview
9
9
years of professional experience
Work History
Utilization Review Manager
Prime Healthcare Management
07.2023 - Current
- Developed and managed a comprehensive Denial Management program, identifying root causes of denials and implementing effective strategies to minimize denials and optimize revenue cycle management.
- Led a team of utilization review specialists in conducting thorough clinical reviews to ensure appropriate utilization of healthcare services and compliance with insurance guidelines and regulatory requirements.
- Streamlined robust clinical appeal processes to refute denials and overturn unfavorable decisions, resulting in increased reimbursement rates and improved financial performance.
- Created and analyzed performance metrics and reports to monitor utilization review process, identify trends, and implement targeted interventions for process improvement.
- Provided ongoing training and education to staff on utilization review best practices, regulatory updates, and effective denial management strategies.
Utilization Review Supervisor
Prime Healthcare
02.2021 - 06.2023
- Oversaw and managed the Utilization Review Process, ensuring compliance with industry standards and regulatory requirements.
- Efficiently used data-driven insights to reduce denial rates, improve the timeliness of authorizations, and enhance the quality of utilization reviews.
- Conducted concurrent reviews for inpatients using InterQual criteria and Milliman Care Guidelines.
- Communicated regularly with internal departments regarding changes in policies or procedures that affect the utilization review workflow.
Medical Review Coordinator
Prime Healthcare
07.2018 - 02.2021
- Monitored the authorization process for traditional Medicaid and commercial payors.
- Enhanced operational workflows by maintaining well- organized documentation system and updating records accurately as needed.
- Coordinated and assisted in clinical reviews for the Utilization Review Process using EMRs such as Epic, Meditech, Cerner, Magic, and other applications like OneContent, Onbase, Relay.
- Effectively communicated with insurance companies and external auditors, facilitating the review process, and addressing inquiries promptly.
- Participated in regular team meetings and contributed to discussions on case management, compliance updates, and quality assurance.
Associate Dentist
Care32 Dental Clinic
06.2015 - 05.2016
- Examined 1500 patients with dental anomalies, including oral cancers, and interpreted radiographs and diagnostic tests to diagnose dental illnesses
- Treated dental abnormalities by performing root canals, tooth extractions, scaling, and constructing dentures
- Created preventative treatment plans and educated patients on dental health
- Monitored patient volume and maintained patient records.
Education
Doctorate in Business Administration -
Westcliff University
Irvine, CaliforniaMaster of Public Health in Health Education & Promotion -
National University
San Diego, California01.2018
Bachelor's of Dental Surgery -
Manubhai Patel Dental College
Vadodara, India01.2015
Skills
- Interpersonal and written communication
- Multitasking
- Data Mining and Reporting
- Project Planning
- Utilization Management
- Team Leadership
- Performance reviewing
- Clinical assessment
- Quality Improvement
- Managing Operations and Efficiency
Timeline
Utilization Review Manager
Prime Healthcare Management
07.2023 - Current
Utilization Review Supervisor
Prime Healthcare
02.2021 - 06.2023
Medical Review Coordinator
Prime Healthcare
07.2018 - 02.2021
Associate Dentist
Care32 Dental Clinic
06.2015 - 05.2016
Doctorate in Business Administration -
Westcliff University
Master of Public Health in Health Education & Promotion -
National University
Bachelor's of Dental Surgery -
Manubhai Patel Dental College
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