VALERIE BANKS
Duluth,GA
Summary
Dynamic and highly motivated Medical Management professional dedicated to leveraging a diverse skill set to enhance business performance. Proven ability to thrive in both individual and team environments, utilizing a strong work ethic to adapt swiftly to various processes and drive organizational objectives. Resourceful and results-oriented with a passion for fostering growth and efficiency that aligns with company goals while maximizing service value. Committed to delivering impactful solutions that contribute to overall success and continuous improvement.
Overview
15
15
years of professional experience
Work History
MEDICAL MANAGEMENT SPECIALIST II
Anthem Blue Cross and Blue Shield
Atlanta, GEORGIA
09.2016 - Current
- Create reports and analyze data to help increase member and provider engagement.
- Utilize ACMP and HIP systems to retrieve member and provider information as needed.
- Guide clinical management teams with data insights, enhancing goal achievement and operational efficiency.
- Develop training materials for Case Managers on best practices in clinical management processes.
- Resolve issues in a timely manner while maintaining high levels of professionalism.
UTILIZATION MANAGEMENT REPRESENTATIVE
Anthem Blue Cross and Blue Shield
Atlanta, GEORGIA
06.2011 - 09.2016
- Coordinated pre-certification cases, enhancing process efficiency.
- Adhered strictly to confidentiality requirements when handling sensitive information.
- Monitored member eligibility, authorizations, denials, appeals and grievances.
- Responded promptly to provider inquiries via phone regarding authorization status.
Education
Bachelor of Science - Marketing
Jacksonville State University
Jacksonville, AL, USSkills
- Teamwork and collaboration
- Problem-solving
- Time management
- Prepare Reports
- Adaptability and flexibility
- Detail-oriented
- Interpersonal skills
- Microsoft Office
- ACMP
- Sharepoint
Accomplishments
- Used Microsoft Excel to develop member text to chat tracking spreadsheet for metric reports. .
- Developed Cancer Care Engagement desktop trainings for Case Managers.
Timeline
MEDICAL MANAGEMENT SPECIALIST II
Anthem Blue Cross and Blue Shield
09.2016 - Current
UTILIZATION MANAGEMENT REPRESENTATIVE
Anthem Blue Cross and Blue Shield
06.2011 - 09.2016
Bachelor of Science - Marketing
Jacksonville State University
AWARDS
Elevance Health Impact Award recipient 2021 and 2023.