Medical Records Utilization Management

Christopher May

**** ***** ******* ******, *******, IL 60608

773-***-**** ********@***.***

Professional Summary:

Over twenty years of diverse professional human service experience with strong clinical, management, and training skills. Professional expertise includes strategic planning, program development, organizational needs assessment, and staff development. Strengths in process standardization, team facilitation, and data management. Fluent in Swedish. Education:

University of Illinois at Chicago (UIC), School of Medicine Doctor of Medicine Received May 1998

Syracuse University

Bachelor of Science in Biology Received May 1984

Skills:

• Microsoft Word

• Microsoft Excel

• Microsoft PowerPoint

• Problem Resolution

• Team Leadership

• Electronic Medical Records

• Communication

Professional Experience:

Medical Private Contractor, Chicago, IL September 2023 – Present Utilization Management Specialist

• Evaluated and assessed medical records, diagnostic tests, treatment plans and additional medical documentation

• Appraised the necessity and appropriateness of services rendered and identified any discrepancies Duly Health and Care, Chicago, IL April 2021 – September 2023 Utilization Management

• Reviewed and submitted medical charts for insurance company regulatory compliance

• Adhered to insurance industry regulation compliance standards and internal policies governing claims and data security

• Reviewed and submitted medical charts for insurance company approval Doctors on Wheels, Chicago, IL May 2011 – January 2016 Medical Coder and Biller

• Reviewed and processed Medicare charts and approvals for all physicians and checked them for submission to Medicare May Medical Center, Chicago, IL August 2013 – January 2016 Medical Coder and Biller

• Used computers for database management or word processing

• Reviewed records for completeness, accuracy, and compliance with regulations

• Retrieved patient medical records for physicians, technicians, or other medical personnel

• Entered data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment

• Assigned patient to diagnosis-related groups (DRGs), using appropriate computer software

• Transcribed medical reports and trained medical records staff May Medical Center, Chicago, IL May 2011 – August 2013 Family Practice Physician

• Led inner-city public clinic composed of other physicians and nurses to treat minority patients Gibson General Hospital, Princeton, IN 2008 – May 2011 Family Practice Physician

• Led team environment composed of other physicians and nurses to efficiently treat and meet the needs of patients May Medical Center, Chicago, IL 2004 – 2008

Family Practice Physician

• Directed management of support staff

• Treated numerous patients and reviewed records for accuracy and compliance

• Used computers for data management and word processing

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