Hi, I’m
LAKENDRIA SIMS
Montgomery
Summary
Detail-oriented and compassionate Utilization Review Specialist with over 8 years of healthcare experience, specializing in Medicare and Medicaid. Proven track record of delivering exceptional remote customer service, streamlining authorization processes, and ensuring regulatory compliance. Skilled in critical thinking, effective communication, and maintaining high levels of patient satisfaction in remote environments.
Overview
4
years of professional experience
1
Certification
Work History
Molina Healthcare
Remote Utilization Management Representative
02.2022 - Current
Job overview
- Facilitated remote coordination of patient services, improving response times and patient satisfaction.
- Verified insurance eligibility and benefits, ensuring accuracy in claims and authorizations.
- Collaborated with providers to efficiently collect prior authorization documentation.
- Trained new team members in HIPAA-compliant remote procedures and systems.
- Conducted preservice and admission reviews, concurrent reviews, and transitional care planning.
- Implemented discharge planning and ensured continuity of member care post-hospital discharge.
- Managed after-hours availability and retrospective reviews, providing medical case management for specific conditions.
- Developed clinical policies and criteria, processed provider appeals, and analyzed utilization data for compliance.
TTEC StaffingServices Inc.Montgomery
Remote Call Center Representative
11.2021 - 01.2023
Job overview
- Evaluated customer information to resolve issues, develop solutions, and maintain high service quality.
- Engaged with customers regarding concerns with products and services to drive sales and resolve problems.
- Enhanced productivity by adhering to call scripts while maintaining control over conversation direction.
- Consistently exceeded revenue quotas through effective product and service promotion during calls.
- Preserved revenue streams by employing strong communication and negotiation skills, offering refunds as a last resort to ensure customer satisfaction.
Education
Nursing Academy of Montgomery
Certified Nursing Assistant (CNA)
05.2006
Selma High School
High School Diploma
05.2005
Faulkner University
Associate of Business Administration from Management
Selma University
Phlebotomy Certification
Skills
- Remote Customer Service
- Medicare & Medicaid Knowledge
- Utilization Management
- HIPAA Compliance
- Prior Authorizations & Insurance Verification
- Medical Documentation & Records Management
- Microsoft Office & Excel
- Clinical Assessment & Discharge Planning
- Call Center & Telehealth Communication
- EMR/EHR Systems
Certification
- CNA – Certified Nursing Assistant
- NHA – Clinical Medical Assistant
References
Available Upon Request
Timeline
Remote Utilization Management Representative
Molina Healthcare
02.2022 - Current
Remote Call Center Representative
TTEC StaffingServices Inc.
11.2021 - 01.2023
Nursing Academy of Montgomery
Certified Nursing Assistant (CNA)
Selma High School
High School Diploma
Faulkner University
Associate of Business Administration from Management
Selma University
Phlebotomy Certification
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