Madison Whittington
Seal Beach,CA
Summary
Insightful Utilization Review Specialist recognized for high productivity and efficient task completion. Skilled in thorough medical record evaluation, effective communication with healthcare providers, and adept at regulatory compliance. Excel in critical thinking, problem-solving, and adaptability to dynamic healthcare environments. Committed to optimizing patient care outcomes while ensuring adherence to healthcare policies and procedures.
Overview
9
9
years of professional experience
Work History
Utilization Review Specialist
Newport Healthcare
Irvine, California
11.2021 - 10.2026
- Managed an active caseload of up to 25 clients across multiple levels of care, including substance use, residential, partial hospitalization (PHP), and intensive outpatient (IOP), coordinating initial, concurrent, discharge, and retrospective reviews to support continuity of care and insurance coverage.
- Collaborated with interdisciplinary treatment teams, clinicians, psychiatrists, and insurance case managers to review clinical documentation, communicate medical necessity, and advocate for appropriate treatment authorizations and continued care for up to 10 reviews per day.
- Maintained accurate and timely documentation in electronic medical records (EMR) and customer relationship management (CRM) systems while communicating authorization updates and coverage decisions to clinical teams, insurance representatives, and clients’ families.
Patient Service Representative
Coury and Buehler Physical Therapy
Irvine, California
09.2020 - 10.2021
- Coordinated communication of insurance benefits to patients prior to appointments, enhancing understanding of coverage.
- Updated patients on insurance information and its impact on financial responsibility for treatment, ensuring transparency.
- Meticulously audit patient accounts to reduce potential discrepancies within
insurance coverage. - Improved the organization and efficiency of the check in process for 180 patients per day.
Newborn Hearing Screener
Pediatrix Medical Group/Hoag Hospital
Newport Beach, California
12.2017 - 09.2020
- Performed Auditory Brainstem Response (ABR) hearing screenings on about 10 newborn patients per shift.
- Coordinated follow-up referrals for newborns needing additional testing.
- Communicated patient results clearly with nurses and pediatricians.
- Documented hearing screening results accurately in electronic medical record and physical chart.
Education
Bachelor of Science - Kinesiology
California State University, Fullerton
Fullerton, CA05-2019
Skills
- EMR documentation
- Case Management
- Medical necessity
- Authorization management
- Time management
- Account auditing
- Clinical documentation
- Attention to detail
- Treatment planning
- Scheduling
- Clear communication
- Medical Terminology
Timeline
Utilization Review Specialist
Newport Healthcare
11.2021 - 10.2026
Patient Service Representative
Coury and Buehler Physical Therapy
09.2020 - 10.2021
Newborn Hearing Screener
Pediatrix Medical Group/Hoag Hospital
12.2017 - 09.2020
Bachelor of Science - Kinesiology
California State University, Fullerton