Montrell Woods
Zachary,LA
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
15
15
years of professional experience
Work History
UM Administration Coordinator II
Humana
10.2022 - Current
- Oversaw utilization management processes to support adherence to payer guidelines and verify medical necessity of services.
- Evaluated coverage limits and confirmed eligibility for services to ensure compliance with policy guidelines.
- Assessed clinical documentation for completeness and collaborated with providers to ensure acquisition of required records.
- Supported authorization processes by addressing escalations, conducting pre-service appeals, and facilitating peer-to-peer coordination.
- Recorded interactions in CRM systems to ensure compliance with HIPAA and QA regulations.
- Developed and implemented training programs for new hires to ensure accuracy in managing high-volume tasks.
- Enabled seamless remote operations to enhance productivity and efficiency.
Transition of Care Specialist
Magellan Health
07.2017 - 10.2022
- Streamlined care transitions to enhance member access to providers and community resources.
- Streamlined utilization case and disease management processes to ensure seamless patient care.
- Conducted data analysis to support improved care coordination and streamline operational processes.
- Coordinated efforts with clinical teams and implemented training programs for new staff to improve overall team effectiveness.
Clinical Administrative Coordinator
United Healthcare
Baton Rouge, LA
07.2015 - 04.2017
- Assigned members to qualified care coordinators to ensure alignment with clinical needs.
- Ensured accuracy of member records while facilitating effective communication between providers and case managers.
- Coordinated efforts to improve service delivery and elevate member outcomes through effective care management.
Provider Advisor II / Team Lead
Blue Cross Blue Shield
Baton Rouge, LA
01.2011 - 07.2015
- Addressed complex provider issues regarding claims benefits and reimbursements.
- Assisted in conducting audits to enhance workflow efficiency. Supported the development of training materials to improve team skills. Collaborated with colleagues to streamline processes and boost productivity.
- Attained 100% quality scores, earning recognition for exceptional performance and collaboration.
Education
Diploma - Medical Assistant
Remington College
Baton Rouge, LASkills
- Insurance Verification
- Prior Authorization & Appeals
- Medicare & Commercial Payors
- Patient Responsibility (Deductibles/ Coinsurance)
- Care Coordination
- Clinical Documentation Review
- Referral Management
- Revenue Cycle Support
- CRM Systems
- HIPAA Compliance
- Time Management
- Microsoft Office
- Google Workspace
- Data Tracking Tools
- Medical Terminology
- Customer database systems
- Administration and operations
- Customer service
- Active listening
- Task prioritization
- Professionalism
- Complex Problem-solving
- Written communication
Timeline
UM Administration Coordinator II
Humana
10.2022 - Current
Transition of Care Specialist
Magellan Health
07.2017 - 10.2022
Clinical Administrative Coordinator
United Healthcare
07.2015 - 04.2017
Provider Advisor II / Team Lead
Blue Cross Blue Shield
01.2011 - 07.2015
Diploma - Medical Assistant
Remington College