Workers Compensation Utilization Review
Resume:
***** *. ****** ***** *********
Oro Valley, AZ **755
Cell: 619. 600. 2899 Email: aduequ@r.postjobfree.com
CORINNA C. PARTAIN “CORI”
OBJECTIVE
I am seeking a full-time position that will utilize my skills in a position with an organization with potential to advance. My work ethic is beyond reproach. I am extremely dependable, punctual, and dedicated, with the ability to get the job done without hesitation and according to goals and objectives of the organization.
SUMMARY OF QUALIFICATIONS
Background encompasses strong leadership skills with over eleven (11) years’ experience in the Utilization Review environment/division. Experience includes the following: extremely proficient in written/verbal communication, problem-solving, negotiation skills, leadership skills, employee guidance, employee education, and lead support to the Utilization Review Department, ascertain compliance with the timeliness of reviews, examining and processing of Workers Compensation claims, exceptional attention to detail, mentoring staff on compliance with departmental policies and procedures, a keen sense of balance between healthcare providers and payors relating to comprehensive and reliable retrospective claims/bills submission.
EMPLOYMENT
January 13, 2020 - August 11, 2021 Department of Economic Security
Program Service Evaluator III
Determine eligibility for Arizonans in need of Nutrition Assistance, Medical Assistance and/or Temporary Assistance to Needy Families.
February 5, 2018 - July 5, 2018 (contract)
Centene Corporation Tucson, AZ
Claims Analyst
Position Purpose: Process pended medical claims, verifying and updating information on
submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure
payments and/or denials are made in accordance with company practices and procedures.
2006 – August 22, 2017 York Insurances Services Group, Inc. Riverside, CA
Sr. Utilization Review Coordinator
Responsible for leading and supporting the medical review coordinators in the Utilization Review Department that review treatment to determine medical necessity and process retrospective, prospective and/or concurrent Workers Compensation treatment requests in a timely fashion; Use of ICD-10-CM/ICD-9-CM and CPT code assignment for retrospective claims review, train and mentor staff as appropriate, Responsible for the coordination, execution and workflow quality of the Utilization Review processes, querying the status of active claims to ascertain status and timeliness of the claims processing and forwarding to the appropriate claims examiner for follow-up, assist claims examiners to make sure their needs are met to process injured workers claims in a timely fashion . Communicate progress as well as challenges to UR. Respond to vendors/clients/injured workers’ needs/concerns as appropriate.
2005 – 2006 Inland Empire Spine & Rehab Medical Center Fontana, CA
Billing & Collections Specialist
Post payments for all payers; Collections; Billing for orthopedic services rendered.
Skills:
MS Office: Word; Outlook; Excel (basic); 40 WPM
References:
Stacey Lester
Medicare Complaints and Appeals Consultant Years Known: 10
Ursula Kregger RN
Years Known: 12
Kathy Delahanty RN
Years Known: 12
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