ANITA MASON

Summary

Upper Darby PA *****

Home: 267-***-****

ad0hh0@r.postjobfree.com

As a Utilization Review Coordinator, I review appeals before being mailed to various insurance providers by data entry into EPIC, using Auth tools for tracking data, making calls to providers for delivery receipt and appeal final status, reviewing authorizations, expediting reviews and appeals. I work with case managers, corporate and facility utilization to maintain integrity of government reviews such as RAC and MAC payer audits. I have uncompromising ethics, am results driven, and I have excellent communication traits. I am disciplined and a hardworking team player.

Skills

● Excellent Oral and written communication

● Exceptional organizational skills

● Time Management

● Microsoft Word

● Data Entry in EPIC and OnBase

● Knowledge of various Health Insurances

Education

Grand Canyon University-Mental Health Science December 2020 Experience

Laid off as 1 of 70 employees following a company restructuring at Independence Blue Cross November 2017 Community Suburban Hospital August 2022-Present

Utilization Review Tech

Norristown, Pa

• Review appeals denial process with knowledge of various commercial and Medicaid vendors

• Document and track communication with insurance companies and health plans via phone

• Document findings in EPIC and OnBase applications while executing time management and set deadlines

• Knowledge of state and federal regulatory requirements and knowledge of medical terminology

• Trained new Utilization Techs-scanning mail into RightFax, forwarding email responses for IRO processing, review and mailing process of appeals and follow up phone calls to Insurance companies for receipt of appeals and outcomes.

AmeriHealth Caritas March 2021 to August 2022

Provider Claims Services Representative

Philadelphia, PA

● Answered 30+ inbound calls per day to address provider inquiries, resolve provider claims issues,

● Obtained information to resolve provider inquiries by using company-based applications

● Guaranteed positive customer experiences in a courteous manner and resolved provider complaints.

● Strong interpersonal skills and conflict resolution techniques. Independence Blue Cross June 2004 to November 2017 Business Specialist

Philadelphia, PA

● Performed intake to delegate Provider Demographic from Pa., De. and NJ providers to teammates

● Utilized Microsoft Access, Excel and Outlook for emails and reports

● Maintained professionalism and exhibited excellent customer service skills via phone

● Findings are updated in provider directory

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