Kaleena McCray
Indianapolis,IN
Summary
Highly motivated and positive individual with great organizational and communication skills. Provider and customer care master and an efficient problem solver. Deftly manage administrative functions. Provide thorough answers and solutions and provide an exceptional provider and customer care experience.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Utilization Management Rep III
Elevance Health- Anthem
Indianapolis, Indiana
05.2014 - 05.2026
- Facilitated the coordination of cases for pre-certification and prior authorization review.
- Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
- Created Inpatient and Outpatient request and refers cases requiring clinical review to a Nurse reviewer.
- Managed the identification and data entry of referral requests into the UM system according to the plan certificate.
- Responds to telephone and written inquiries from clients, providers and in-house departments.
- Conducts clinical screening process and Authorizes initial set of sessions to provider. Checks benefits for facility based treatment.
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner per Data Entry and processing for prior authorization.
- Conducted training sessions for peers on multiple programs.
- Processing faxes from a provider per data entry at an accelerated rate to meet the quota of more than 80-100 faxes per day.
- Minimized documentation errors by 30% within 3 months through meticulous coordination and review processes.
- Managing incoming calls or incoming fax requests in a professional environment. Promoted to off-phone in remote environment.
- Follow up on the Provider's case and concerns and resolve problems.
Education
High School Diploma -
Ben Davis High School
Indianapolis, INSkills
- ICD-10 and CPT coding
- Data entry
- 10-Key Data Entry
- Documentation
- Document interpretation
- High volume work
- Multi-system experience
- Customer Care
- Inbound and outbound calling
- Microsoft Excel
- Outlook
- Word
- MS Office
- Reporting
- Software management
- Analytical Thinking
- Critical Thinking
- Problem solving Skills
- Attention to Detail
- Organizational Skills
- Time Management
- Multi-tasking
- Independent work
- Teamwork
- Training
- Professionalism
- Interpersonal skills
- Correspondence management
- Strategic planning
- WGS mainframe
- RightFax Experience
- Word and Office equipment
- Case coordination
Certification
- Certified Nurses Assistant (CNA)
- First Aid Certification
Awards And Scholarships
Values in Action Award
Timeline
Utilization Management Rep III
Elevance Health- Anthem
05.2014 - 05.2026
High School Diploma -
Ben Davis High School