Lauren Higgins
Wahiawa
Summary
Dedicated healthcare and administrative professional with expertise in Medicare counseling, patient advocacy, and program coordination within behavioral health settings. Demonstrates strong case management, training, and communication skills, with a background in serving aging and disabled adults. Seeking a remote Utilization Review Specialist position to contribute to compliance, patient care optimization, and effective healthcare coordination.
Overview
7
7
years of professional experience
Work History
Case Aide
The Resource Exchange
Colorado Springs
2024.02 - 2025.12
- Support adults and children with intellectual, behavioral and developmental disabilities, as well as their families, in care planning and service delivery.
- Draft and revise individualized service plans (ISPs), including annual service plans, plan revisions, and terminations, ensuring accuracy and compliance with state and Medicaid regulations.
- Communicate with families and providers to review services, notify of updates, and ensure understanding of changes and authorizations.
- Review prior authorization (PAR) submissions, track approvals and denials, and update member records accordingly.
- Maintain accurate client data and change-of-information updates in confidential member files using platforms such as Excel, CCM, Medisked, Docusign and Nitro Pro.
- Train new staff and peers on plan documentation procedures and system navigation.
- Delivered unbiased Medicare and Medi-Cal counseling to seniors and disabled adults, improving benefits access and care continuity.
- Conducted community outreach and training presentations on healthcare benefits, coverage rules, and appeals procedures.
- Prepared and submitted APS reports involving elder abuse, self-neglect, and dependent adult abuse.
- Guided clients through insurance enrollment processes and Medi-Cal renewals.
- Demonstrated extensive experience in managing state and private insurance appeals and authorizations.
- Partnered with senior centers and community agencies to identify and support at-risk populations.
- Maintained strict documentation and compliance with HIPAA standards and regulatory procedures.
Program Technician / HICAP Counselor
Kern County Aging and Adult Services
Bakersfield
2020.10 - 2022.09
Pre-Imaging Service Representative
Austin Radiological Association
Austin
2019.04 - 2019.12
- Scheduled diagnostic imaging services and ensured accurate insurance and diagnosis code alignment (ICD-10).
- Created and managed patient/provider accounts and ensured secure handling of PHI.
- Collaborated with referring physicians to coordinate pre-authorizations and resolve procedural discrepancies.
- Provided remote administrative support while maintaining productivity and service standards.
- Conducted member outreach to communicate insurance updates, plan resources, and enrollment options.
- Supported members in accessing care and using the patient portal, improving service utilization.
- Processed eligibility verification and facilitated plan changes during enrollment periods.
- Maintained accurate service documentation and followed compliance standards.
Retention Specialist
Scott & White Health Plan
Temple
2018.08 - 2019.01
Education
Master of Business Administration - MBA
University of Phoenix
2018-05
Bachelor of Science - Health Administration, Health Management
University of Phoenix
2016-02
Associate of Science - Medical Assisting
San Joaquin Valley College
2012-02
Skills
- Medicare & Medicaid Counseling
- Advanced Case Management & Patient Advocacy
- Insurance Enrollment & Documentation Compliance
- HIPAA Compliance & APS Reporting
- Community Outreach & Training
- Microsoft Office
- Google Workspace
- TEAMS
- Docusign
- CCM
- Medisked
- Nitro Pro
- ICD-10 Coding Knowledge
- Excellent Written and Verbal Communication
References
Available upon request
Timeline
Case Aide
The Resource Exchange
2024.02 - 2025.12
Program Technician / HICAP Counselor
Kern County Aging and Adult Services
2020.10 - 2022.09
Pre-Imaging Service Representative
Austin Radiological Association
2019.04 - 2019.12
Retention Specialist
Scott & White Health Plan
2018.08 - 2019.01
Master of Business Administration - MBA
University of Phoenix
Bachelor of Science - Health Administration, Health Management
University of Phoenix
Associate of Science - Medical Assisting
San Joaquin Valley College