Open To Work
Sheng Thao
Elkland,MO
Summary
Experienced healthcare professional specializing in medical and behavioral health intake, prior authorizations, claims review, and care coordination. Manages high-volume workloads with precision and compliance while delivering exceptional service. Expertise in CPT/HCPCS and ICD-10 coding, authorization processing, and cross-functional collaboration to enhance operational efficiency.
Overview
10
10
years of professional experience
Work History
UM Auth Specialist II
Clearlink Partners
Charleston, South Carolina
06.2025 - 02.2026
- Processed and triaged medical and behavioral health authorization requests and faxes to appropriate departments and member accounts.
- Utilized CPT, HCPCS, Revenue, and ICD-10 codes to accurately review and process authorization requests.
- Provided verbal determination notifications to members and providers while maintaining HIPAA compliance.
- Ensured pre-certifications and authorization tasks met required turnaround time standards.
- Utilized Microsoft Office applications including Excel, Outlook, PowerPoint, and OneNote for reporting and communication.
UM Intake Coordinator
Toney Healthcare Consulting
Tampa, Florida
11.2024 - 06.2025
- Managed inbound and outbound calls with providers and members regarding authorization requests and status updates.
- Researched and processed first-level and second-level appeals, retrospective reviews, and claims-related requests.
- Triaged authorization requests and medical documentation accurately and efficiently.
- Assisted with Post Transition of Care (PTOC) cases for the Care Management Department.
- Supported team operations during peak caseloads through cross-training and task assistance.
- De-escalated member and provider concerns while ensuring accurate resolution and customer satisfaction.
UM Senior Care Coordinator
Brighton Health Plan Solutions
Westbury, New York
04.2023 - 10.2024
- Processed utilization management authorization requests, including intake validation and provider/member verification.
- Reviewed diagnosis and procedure coding to support authorization approvals and processing accuracy.
- Approved authorization requests that did not require pre-certification review.
- Coordinated outreach to providers for clinical documentation, concurrent review updates, and discharge information.
- Trained and mentored newly onboarded associates and provided refresher training to team members.
- Assisted leadership with implementation and formatting updates for the Medical Management system.
- Generated and distributed ADHOC reports, monitored turnaround times, and escalated urgent authorization cases to management.
Senior Clinical Service Associate
Bright Health
Lee's Summit, Missouri
11.2020 - 04.2023
- Managed high-volume inbound and outbound communications with providers and members regarding authorization requests and status inquiries.
- Processed authorization intakes, verified HIPAA compliance, and ensured accurate documentation entry.
- Coordinated peer-to-peer scheduling with Medical Directors and external review organizations.
- Conducted outreach for missing clinical documentation and concurrent review requirements.
- Performed auditing and coaching activities to support quality assurance initiatives.
- Assisted supervisors with production reporting, spreadsheets, process documentation, and workflow improvements.
- Trained new team members and facilitated provider webinars on authorization submission procedures and portal navigation.
Complex Auth Specialist
TriWest Healthcare Alliance
Kansas City, Missouri
11.2015 - 06.2020
- Initiated and maintained authorization requests for healthcare services, ensuring timely processing.
- Reviewed and attached clinical documentation to support authorization processing.
- Coordinated with providers and VA representatives to obtain necessary information, facilitating efficient authorization.
- Trained, audited, and coached associates across multiple functional job duties and workflows.
Education
Certificate - Dental Assisting
Carrington College
Sacramento, CA04-2010
High School Diploma -
Visions in Education Charter School
Carmichael, CA06-2001
Skills
- Utilization Management (UM) and Authorizations
- Medical and Behavioral Health intake
- CPT/HCPCS and ICD-10 coding
- Claims research and Appeals
- Provider and Member relations
- HIPAA Compliance
- Medical documentation review
- Call de-escalation and resolution
- Workflow optimization
- Team training and coaching
- Quality Assurance and Auditing
- Microsoft Office Suite proficiency
- Cross-functional collaboration
- Turnaround time management
Work Preference
Job Search Status
Open to workWork Type
Full TimeLocation Preference
RemoteSalary Range
$55000/yr - $200000/yrTimeline
UM Auth Specialist II
Clearlink Partners
06.2025 - 02.2026
UM Intake Coordinator
Toney Healthcare Consulting
11.2024 - 06.2025
UM Senior Care Coordinator
Brighton Health Plan Solutions
04.2023 - 10.2024
Senior Clinical Service Associate
Bright Health
11.2020 - 04.2023
Complex Auth Specialist
TriWest Healthcare Alliance
11.2015 - 06.2020
Certificate - Dental Assisting
Carrington College
High School Diploma -
Visions in Education Charter School