Sheng Thao
Elkland,MO
Summary
Dedicated professional prepared to bring extensive expertise and results-oriented approach to Specialist role. Known for effectively managing tasks and supporting organizational goals through collaborative efforts and adaptive strategies. Recognized for excellent communication and analytical skills, ensuring seamless operations and consistent outcomes.
Overview
10
10
years of professional experience
Work History
UM Auth Specialist II
Clearlink Partners W/ Fidelis Care
06.2025 - 02.2026
- Triage Medical and Behavioral Health faxes to the correct Member, Authorization or initiate an Authorization.
- Knowledge of CPT/HCPC/Rev Codes and ICD 10 Codes.
- Knowledge of Excel, Power Point, Outlook, One Note, etcs.
- Verbal notifications of determinations made to the Members and Providers.
- Ensure all tasks and pre-certifications are completed within the designated turnaround time parameters as required.
UM Intake Coordinator
Toney Healthcare W/ Uniformed Services Family Health Plan
11.2024 - 06.2025
- Triage faxes to the correct Member, Authorization or initiate an Authorization.
- Take Inbound and Outbound Calls from/to Members and Providers. Initiate and or check Authorization Status. Provide accurate information and de-escalate calls. Reach out to Clinicians/Leadership for assistance if needed.
- Ensure all tasks and pre-certifications are completed within the designated turnaround time parameters as required.
- Assist co-workers in completion of critical tasks during times of peak caseloads/cross training and ability to cover in different teams where necessary.
- Assist with the Post Transition Of Care (PTOC) Cases for the Care Management Dept.
- Research and analyze Faxes and Appeals requests pertaining to First Level and Second Level Appeal Cases.
- Research and analyze Faxes and Claims requests pertaining to Claims and or Retrospective requests. Assuring requests are within the timely filing.
UM Senior Care Coordinator
Brighton Health Plan Solutions
04.2023 - 10.2024
- Triage fax to the correct Member, Authorization or initiate an Authorization.
- Intake, Validating the Authorization by inputting the Providers information, type of request, diagnosis codes, CPT Codes, HIPAA verifying the Member in an accurate and timely manner.
- Approve Authorization requests that does not require pre-certification.
- Outreaches to Providers to request Initial Clinicals, Concurrent Review Clinicals, Discharge Summary/Date, Discharge disposition and other lack of information.
- Train new onboarding Associates and provide refreshers to the Team.
- Assist Management with the new Medical Management system and formatting.
- Works closely with Management, Clinicians and the Team; individually, on projects and escalated email requests. Etcs.
- Pull the ADHOC reports; filter, assign them to the appropriate Teams and inform Management of any Authorizations closed to or past the turnaround time.
Senior Clinical Service Assoc.
Bright HealthCare
11.2020 - 04.2023
- Take Inbound and Outbound Calls from Providers and Members.
- Initiate and or check Authorization Status. Provide accurate information and de-escalate calls. Reach out to Clinicians for assistance if needed.
- Triage fax to the correct Member, Authorization or initiate an Authorization.
- Intake, Validating the Authorization by inputting the Providers information, type of request, diagnosis codes, CPT Codes, HIPAA verifying the Member in an accurate and timely manner. Assure Turn- around-Time is met.
- Peer to Peer scheduling to the Medical Directors or External MRIoA.
- Outreaches to Providers to request Initial Clinicals, Concurrent Review Clinicals, Discharge Summary/Date and other lack of information.
- Verbal Notifications to Providers/Facility on Authorization outcomes.
- Assign and re-assign tasks to Associates.
- Audit and provide Coachings.
- Assist Supervisors with pulling and inputting reports, production, creating job aides and spreadsheets to accommodate our job processes, etcs.
- Train new onboarding Associates and provide refreshers to the Team.
- Provide Webinars to Providers, on how to submit Authorizations. Walkthrough of the Provider Portal (Availity) and the Bright HealthCare website for the Authorization Navigator to determine if the Service(s) requires an Authorization, along with finding the Prior Authorization Request Form.
Complex Auth Specialist
TriWest Healthcare Alliance
11.2015 - 06.2020
- Initiate, Upload and Extend Authorization requests.
- Intake and attach clinical documents.
- Outreaches to the Providers and or VA for missing information.
- Train, Audit and Coach Associates in all areas within the job duties.
Education
Dental Assisting -
Carrington College
Folsom, CA04.2010
Highschool Graduate - undefined
Visions in Education Charter School
Carmichael, CA06.2001
Skills
- Customer relations
- Expert problem solving
- Analytical thinking
- Adaptability
- Documentation management
- Teamwork and collaboration
- Project management
- Quality assurance
- Knowledge sharing
- Coaching and mentoring
- Workflow automation and optimization
- Time management abilities
Timeline
UM Auth Specialist II
Clearlink Partners W/ Fidelis Care
06.2025 - 02.2026
UM Intake Coordinator
Toney Healthcare W/ Uniformed Services Family Health Plan
11.2024 - 06.2025
UM Senior Care Coordinator
Brighton Health Plan Solutions
04.2023 - 10.2024
Senior Clinical Service Assoc.
Bright HealthCare
11.2020 - 04.2023
Complex Auth Specialist
TriWest Healthcare Alliance
11.2015 - 06.2020
Highschool Graduate - undefined
Visions in Education Charter School
Dental Assisting -
Carrington College