Shirley Brown
Douglasville,GA
Overview
9
9
years of professional experience
Work History
Utilization Management, Lead
Anthem
Atlanta, GA
08.2013 - 07.2016
- Over saw entire department of 150 associates in the absence of manager.
- Created and maintained database to track business performances in order to keep metric in line with business needs.
- Collaborated with health care providers and members in the provision of patient care and Prior Approvals and denials.
- Handled all escalated issue via phone call, email and US mail.
- Assisted member and provider with HCPT, ICD-10, CPT approvals by insuring proper medical documentation.
- Ordered and distributed office supplies while adhering to a fixed office budget.
- Screened applicant resumes and coordinated both phone and in-person interviews.
Clinical Operation Specialist
Anthem
Atlanta, GA
07.2010 - 07.2013
- Determined contract and benefit eligibility; provides authorization for inpatient admission; outpatient prior authorization and post service requests.
- Handled escalated cases requiring immediate nurse review.
- Conducted clinical screening proces.
- Continuously multi tasking while maintaining 100% accuracy.
- Responsible for creative design for prominent projects during conference calls.
Utilization Management Specialist
Anthem
Atlanta, GA
01.2008 - 07.2013
- Developed and implemented complex Internet and Intranet applications on multiple platforms.
- Managed incoming calls and incoming post service request.
- Coordinated with systems partners to finalize designs and confirm requirements.
- Continuously met departmental goal and exceptions at 100%.
Education
Associate of Science - Business Administive
St Leo University
Marietta, GA2010
Skills
- Excellent problem-solving abilities
- Excellent communication skills
- Strong verbal and written skills
- Strong Excel skills
- Strong Power Power skills
Timeline
Utilization Management, Lead
Anthem
08.2013 - 07.2016
Clinical Operation Specialist
Anthem
07.2010 - 07.2013
Utilization Management Specialist
Anthem
01.2008 - 07.2013
Associate of Science - Business Administive
St Leo University