Marion Williams
Chesapeake,VA
Summary
Dynamic Utilization Review Representative with a proven track record at Elevance Health, excelling in customer relations and data entry. Adept at managing precertification processes and enhancing operational efficiency through strong organizational skills. Recognized for effectively authorizing services while meeting all HIPAA guidelines and maintaining meticulous attention to detail and fostering positive client interactions.
Overview
21
21
years of professional experience
Work History
Untilization Review Rep II/ Non Clinical
Elevance Health
05.2004 - 05.2025
- Responsible for coordinating cases for precertification and prior authorization review.
- Primary duties may include but not limited to managing faxes or calls and incoming post services claims work.
- Determines contract and benefit eligibility
- Provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service request.
- Refers cases requiring clinical review to a Nurse reviewer.
- Responsible for the identification and data entry of referral requests into the UM system in accordance with 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.
- Check 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..
Education
Associate of Applied Science - Computer And Information Systems
Bryant And Stratton College
Virginia Beach, VASkills
- Customer relations
- Data entry proficiency
- Goal-oriented mindset
- Multitasking
- Attention to detail
- Organizational skills
- Time management
- Problem-solving
- Basic skills in Microsoft Word and Outlook
Accomplishments
- Mentoring a coworker
- Received QIP incentive every quarter by meeting and exceeding company metrics
- Proficient in using the AUMI system
- Employee of the month several times
- Promoted from Customer Service Rep to Utilization Review Rep II -Non Clinical
- Worked on a project for entering NJ OB Globals specifically for Health Plan
Languages
English
Full Professional
Timeline
Untilization Review Rep II/ Non Clinical
Elevance Health
05.2004 - 05.2025
Associate of Applied Science - Computer And Information Systems
Bryant And Stratton College
Similar Profiles
Randi WoodRandi Wood
Provider Resolution Manager Sr. at Elevance HealthProvider Resolution Manager Sr. at Elevance Health
Du NguyenDu Nguyen
System Analyst at Elevance HealthSystem Analyst at Elevance Health
Carol HickeyCarol Hickey
Membership Representative III at Elevance HealthMembership Representative III at Elevance Health
Infinite YoungInfinite Young
Health Benefits Coordinator at Elevance HealthHealth Benefits Coordinator at Elevance Health
Jacob RosebroughJacob Rosebrough
2nd Class Welder at Fairlead Boat Works2nd Class Welder at Fairlead Boat Works