Proven Utilization Review Specialist with a track record of excellence at Emblem Health Insurance and ConnectiCare. Elevated to Senior roles for expertise in Utilization Management and Medicare Compliance, demonstrating exceptional decision-making and team collaboration. Skilled in streamlining processes for improved efficiency, embodying reliability with a focus on healthcare regulations.
Programs used: Salesforce, Facets, Epic, Express Scripts and Microsoft Office
Intake Specialist Utilization Management
Care Specialist UM Intake team- I took a new position with our UM intake prior authorizations department. I input authorizations for the phone and fax requests. I utilize our chat support for assistance and escalations from providers/ Hospitals
11/2023-I was promoted to a Senior Care Specialist position. We assist the care specialists with questions regarding phone and fax inquiries. We also give mentoring sessions, Create and present power point presentations as well as handle all escalations for management.
Concierge Specialist - Farmington, Connecticut
Call center advocate for the City of NY Employees in Farmington, CT. We handle all incoming calls pertaining to members health insurance benefits, billing and claim research.
09/2021- I was promoted to a Senior Advocate/ Floor Support for the same team. We assisted the phone team with any support questions. I worked with other delegated entities to assist in resolving complex member issues.
Health Information and Reimbursement Specialist
Medical terminology, Anatomy and Physiology