utilization management technician resume example with 7+ years of experience
AmeriHealth Caritas Philadelphia, PA
Volunteer Captain May 2015 ā April 2018
ā¢ Submit reports and review reports or problems with superior
ā¢ Provide information or refer individuals to public or private agencies or community services for assistance.
ā¢ Visit individuals in homes or attend group meetings to provide information on agency services, requirements, or
procedures
Ethiopia Student Associations Philadelphia, PA
Communication Coordinator August 2017 ā Current
ā¢ Created different ways for our organization to reach students and doubled the membership within a year
ā¢ Assisted with translation, with Amharic a language spoken in Ethiopia to English, in order to better serve students
inquiries
ā¢ Assisted the leading of weekly meetings as well as helping coordinate the speaker schedule and events for the year
SKILLS & INTERESTS
Technical Skills: MS Office Suite, Excel (Advanced), IAD, EXP, Streamline
Volunteering: Philadelphia Free Library, United By Blue Cleanups, Grace Tabernacle Christian Church, Bingo for the blind,
Minecraft Block by Block Party, Volunteer at Bartramās Garden, Philadelphia Healthy hoops (15th Anniversary Celebration).
Greensboro, NC, 12/2019 - Current
- Supports the daily operations of Utilization Management team through interaction with staff, facilities, vendors and providers.
- Maintains a current knowledge base of Utilization Management processes and timelines.
- Uses good listening skills, conducts outreach calls, collecting data according to script, tools, and protocols meeting both productivity and performance expectations as identified by unit supervisor/or designee. Conducts all calls in a courteous and customer service friendly manner. Refers as appropriate when indicated by workflow.
- Creates, updates maintains and/or closes authorizations or tasks for services as assigned within process guidelines. Routes case to appropriate AmeriHealth associates based on established guidelines.
- Processes all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines. Refers to the appropriate clinical team members for review as defined by workflow.
- Performs in a call center environment appropriately processing or triaging calls from members and providers.
- Clerical responsibilities such as processing urgent scanning, mailing requests, document retrieval, and projects as assigned.
- Demonstrates a professional and courteous manner when communicating with others with the ability to clearly and accurately state the agreed upon resolution.
- Adhere to AmeriHealth Policies and Procedures, process standards, and Standard Operating Procedures
- Performs other related duties and projects as assigned within the assigned timeframes.
- Adheres to AmeriHealth policies and procedures.
- Complies with AmeriHealth and HIPAA confidentiality standards to protect the confidentiality of member information
- Education/Experience:
- High School Diploma or GED required.
- Minimum of 1 year of member service or customer service telephone experience in a call center environment desired.
- Working knowledge of medical terminology.
- Demonstrated ability to work within a fast paced environment and meet turnaround times for deliverables.
- Experience working in a productivity and metric based work environment.
- Experience initiating or processing requests for prior authorization, DME, and/or concurrent review.
- Demonstrated ability to utilize existing resources and engage critical thinking skills to seek out resolutions to problems.
- Demonstrated proficiency utilizing MS Office and Internet applications in a Windows based environment. Familiarity with electronic medical record and documentation programs.
West Palm Beach, FL, 12/2018 - 12/2019
ā¢ Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as
appropriate, and not interrupting at inappropriate times.
ā¢ administrative and clerical procedures and systems such as word processing, managing files and records, stenography and
transcription, designing forms, and other office procedures and terminology
ā¢ Attended and participate in client meetings with senior advisors enhancing my professional experience in the industry
City, STATE, 08/2015 - 12/2018
ā¢ Check to ensure that appropriate changes were made to resolve customers' problems
ā¢ Complete contract forms, prepare change of address records, or issue service discontinuance orders, using computers
ā¢ Confer with customers by telephone or in person to provide information about products or services, take or enter orders,
cancel accounts, or obtain details of complaints.
City, STATE, 01/2014 - 05/2016
ā¢ Explained how various menu items were prepared, describing ingredients and cooking methods.
ā¢ Removed dishes and glasses from tables and counters, and took them to kitchen for cleaning. Also, stocked service areas
with supplies such as coffee, food, tableware, and linens.
ā¢ Took customer's food orders and submitted orders to kitchen staff.
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Resume Overview
School Attended
- Community Collage
- Bartram John - Main
Job Titles Held:
- Utilization Management Technician
- Provider Claim Services
- Bilingual Amharic Rep
- Manager
Degrees
- Associate of Science
- High School Diploma
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