Martha Williams
Indian Land,SC
Summary
Results-driven healthcare data professional with over 3 years of experience in medical coding, prior authorization review, and health information management. Expertise in ICD-10, CPT, and HCPCS coding, along with electronic health records and insurance verification. Skilled in analyzing clinical documentation and ensuring HIPAA compliance while enhancing productivity and data integrity through effective process optimization.
Overview
4
4
years of professional experience
Work History
Seasonal Support Driver
UPS
Fort Mill, South Carolina
10.2025 - 01.2026
- Organized schedule to optimize delivery routes to achieve on-time deliveries across designated routes.
- Operated delivery vehicles while adhering to safety regulations and traffic laws.
- Communicated with dispatch for updated delivery instructions and schedules, ensuring timely adjustments.
- Maintained accurate delivery and vehicle usage logs for compliance and operational efficiency.
RCA
USPS
Fort Mill, South Carolina
03.2025 - 10.2025
- Deliver mail along your assigned route
- Executed day-to-day duties with accuracy and efficiency to ensure timely delivery.
- Sort, lift and push moderate to heavy loads of mail and packages to prepare for delivery
- Pick up or collect mail from customers
- Sell stamps, stamped paper and money orders or other services
- Work indoors and outdoors in all weather: rain, snow, cold and heat
- Analyzed performance metrics to assess project outcomes and identify areas for improvement.
- Collaborated with diverse coworkers to achieve shared goals and resolve product-related issues.
Prior Authorization Specialist
CVS Health / Aetna
10.2024 - 05.2025
- Resolved complex insurance inquiries and coverage issues using comprehensive knowledge of insurance products, regulatory requirements, and organizational policies to enhance client experience and satisfaction ratings.
- Execute insurance verification and policy management for diverse client accounts, processing coverage updates, renewals, and member information changes while maintaining accurate, compliant records of all interactions.
- Troubleshoot member account discrepancies through systematic analysis and proactive problem-solving, identifying root causes and implementing corrective actions that enhance operational efficiency.
- Coordinated cross-functional service delivery with internal departments to implement healthcare products and services while ensuring compliance with industry regulations and company guidelines.
Commercial Review Associate
Cigna Healthcare
05.2022 - 10.2024
- Achieved 98% accuracy rate analyzing clinical data for prior authorization and non-formulary exception requests, ensuring strict protocol adherence and compliance specifications.
- Increased productivity by 30% and reduced turnaround time by implementing streamlined data organization and review tracking system across medical review operations.
- Promoted from pharmacy to medical department for managing complex clinical reviews and demonstrating mastery of formulary requirements, clinical policies, and authorization protocols.
- Abstracted and analyzed clinical documentation using online PA tools to evaluate authorization requests against formulary and clinical policy specifications.
- Conducted quality reviews validating PA and exception requests met approval criteria, referring non-compliant documentation to appropriate clinical teams.
- Researched and resolved complex authorization inquiries from providers and clients by applying knowledge of formulary policies and insurance guidelines.
- Collaborated with pharmacy, medical, and clinical teams to gather information for comprehensive prior authorization and exception request reviews.
- Generated data reports on review findings and KPIs to support data-driven decision-making and identify opportunities for process improvement.
Education
High School Diploma -
Northwestern High School
Rock Hill, SCSkills
- Medical Coding (ICD-10-CM, CPT, HCPCS)
- CMS Guidelines & Medical Terminology
- Chart Review & Abstraction
- Health Information Management (HIM)
- Electronic Health Records (EHR)
- Prior Authorization & Insurance Verification
- Claims Data Entry & Processing
- Patient Records / Medical Documentation
- Quality Review & Auditing
- Data Entry & Management
- Regulatory Compliance (HIPAA)
- Medicare
- Medicaid
- Commercial Insurance
- Medical Records Review
- Healthcare Data Reporting
- Cross-Functional Collaboration
- Problem Resolution
- Customer Service Excellence
- Process Improvement
- Medical Coding Systems: ICD-10-CM, CPT, HCPCS Level II
- Prior Authorization Software
- Claims Processing Systems
- Health Information Databases
- Data Management Platforms
- Microsoft Office Suite: Excel (Data tracking & Analysis)
- Word
- Outlook
- Insurance Systems: Medicare
- Commercial Payer Platforms
Key Strengths
- Medical Coding & Documentation Analysis, Achieved 98% accuracy rate in reviewing complex medical documentation for prior authorization and exception requests, applying ICD-10, CPT, and HCPCS coding knowledge to ensure compliance with formulary and clinical policies. Currently pursuing Medical Billing & Coding certification to enhance technical expertise and expand career opportunities in remote coding and health information management.
- Data Management & Process Optimization, Increased productivity by 30% and reduced request turnaround time through implementation of efficient data organization and review tracking systems. Compiled detailed performance reports on key metrics and trends, contributing to data-driven decision-making and continuous process improvement across medical review operations.
- Quality Assurance & Regulatory Compliance, Promoted from Pharmacy to Medical department based on exceptional performance managing complex clinical reviews and demonstrating mastery of both formulary and clinical requirements. Maintained strict adherence to HIPAA regulations, insurance guidelines, and organizational policies while ensuring accurate interpretation of medical information and authorization specifications.
Timeline
Seasonal Support Driver
UPS
10.2025 - 01.2026
RCA
USPS
03.2025 - 10.2025
Prior Authorization Specialist
CVS Health / Aetna
10.2024 - 05.2025
Commercial Review Associate
Cigna Healthcare
05.2022 - 10.2024
High School Diploma -
Northwestern High School