Microsoft Office, Access, Outlook, KIPU, Zen Chart, Salesforce, Availity, Best Notes, VerifyTX, Collab, etc
Latressa Fletcher
North Plainfield,US
Summary
Utilization Review Coordinator, with 9+ years experience in insurance authorizations and benefit verifications specializing in substance abuse.
Overview
20
20
years of professional experience
1
1
Certificate
5
5
years of post-secondary education
Work History
Utilization Review Manager
EXACT BILLING SOLUTIONS
08.2020 - Current
- Manages and completes pre-certification, concurrent reviews, peer reviews and retro authorizations
- Provides monthly analysis and reporting to upper management of UR trends
- Manages and completes Audits, Medical Record Requests, Prepayment Reviews
- Act as agency liaison with insurance and managed care companies for authorization of treatment costs, representing company in a positive and professional manner
- Participate in staff meetings as needed
- Clear communication with supervisors, co-workers, and facilities
- Keeps abreast of changes to, and monitors compliance with, State and Federal laws and regulations in areas of insurance/ third party payers
- Protects the confidentiality of patients and the privacy of staff
- Uses computer to type correspondence, reports and other items as requested, ensuring that typing is accurate
- Process data in conjunction with the Billing Director in order to present it effectively using established statistical methods
- Demonstrates willingness to accept responsibility and shows initiative
- Performs other duties as assigned by the Chief Billing Officer, such as chart auditing which requires close attention to detail and quality assurance.
Admissions Coordinator
Delray Healthcare
05.2019 - 01.2023
- Maintains admission guidelines by writing, updating, and recommending changes to admission criteria, policies and procedures.
- Markets programs and facilities by preparing and providing informational brochures; writing and placing advertisements; answering questions; conducting tours.
- Obtains applicant information by requesting completed applications and medical information; verifying and clarifying information; interviewing patients and family members; explaining admission criteria.
- Screens patients by comparing patient's condition to admission criteria; evaluating and accepting or rejecting patients; referring patients and family to other programs and institutions.
- Admits patients by completing admission and financial responsibility forms; coordinating and arranging physical, social, emotional, and support service requirements, including transportation.
- Resolves patient/family dissatisfactions by investigating concerns; recommending changes in service policies and procedures.
- Prepares admissions reports by collecting, analyzing, and summarizing data and trends.
Utilization Review Specialist
Inspirations Recovery Center
10.2015 - 04.2019
- Utilization Review Coordinator, with 5+ years experience in insurance authorizations and benefit verifications specializing in substance abuse.
Verification Specialist / Utilization Review
New Beginnings Care
03.2008 - 09.2015
- Maintained and updated information for all patient files.
- Coordinated patient data collection with various external referral source.
- Assessed and adjusted insurance policy medication coverage as required.
- Contacted physician offices for procedure and medication authorizations as needed.
- Verified insurance coverage for patients on all levels of care, deductibles, co-pays, co-insurance, and out of pocket cost.
Customer Portfolio Representative
Dealer Services Corporation
03.2006 - 02.2008
Customer Service Representative
Florida Power & Light
07.2005 - 02.2006
Education
Associate's degree - Certified Addiction Specialist
Palm Beach State College
Lake Worth, FL09.2025
High school or equivalent - General Studies
Cornerstone Academy
Tifton, GA05.1994
Bachelor of Science - Psychology
New Charter University
Salt Lake City, UT 04.2020 - 01.2025
Skills
- ICD 10 codes
- Quality assurance
- ICD-9
- Documentation review
- Insurance Verification
- Collections
- Medical Records
- Medical terminology
- Social work
- Case Management
- Salesforce
- HIPAA Compliance
- Customer service
- Team management
- Microsoft Office
- Excel
- Publisher
- PowerPoint
- Outlook
- Accounts receivable
- Supervising experience
- Leadership
- Managed Care and Non Managed Care Contract Knowledge
- Auditing
- Data management
- Treatment and Discharge Planning
- SharePoint
- ICD-10
- Data collection
- Typing
- Utilization Review
- Medical records
- HIPAA
- Customer support
- CPT
- B2B
Certification
- Business Leadership, 2010-03-01, Present
- Business Leadership Certification
- CPR Certification
- LPN
- RN License
- Driver's License
- LMSW
Accomplishments
Achieved and over seeded monthly KPI's.
Developed and Maintained all Training Material to produce exceptional goals, quotes, CEUs.
Directly responsible for all internal projects, spreadsheets, accuracy, and efficiency.
Achieved Director of the Year Award 5 years in a row.
Supervised team of 10 staff members.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Software
Timeline
Utilization Review Manager
EXACT BILLING SOLUTIONS
08.2020 - Current
Bachelor of Science - Psychology
New Charter University
04.2020 - 01.2025
Admissions Coordinator
Delray Healthcare
05.2019 - 01.2023
Utilization Review Specialist
Inspirations Recovery Center
10.2015 - 04.2019
Verification Specialist / Utilization Review
New Beginnings Care
03.2008 - 09.2015
Customer Portfolio Representative
Dealer Services Corporation
03.2006 - 02.2008
Customer Service Representative
Florida Power & Light
07.2005 - 02.2006
Associate's degree - Certified Addiction Specialist
Palm Beach State College
High school or equivalent - General Studies
Cornerstone Academy
Willing To Relocate
Palm Beach County, FL
Personal Information
- Authorized To Work: US
- Availability: Willing to relocate to: Florida - Palm Beach County, FL
- Visa Status: Authorized to work in the US for any employer
- Driving License: Driver's License
- Work Permit: Authorized to work in the US for any employer
Willing To Relocate
Palm Beach County, FL
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