Behavioral Health Prior Authorization

ABBY OCKLER

MENOMONIE, WISCONSIN

715-***-**** **********@*****.***

LINKEDIN.COM/IN/ABBYOCKLER

SHE/HER AVAILABLE IMMEDIATELY

Hi there, I’m Abby and I have always been a mission-driven and results-oriented behavioral health care administrator with over 10 years of experience spanning--clinical operations, insurance navigation, and direct client care. I’ve also spent years becoming specialized in prior authorization, payer/contract negotiations, and revenue-cycle management for residential, outpatient, and integrated health settings, including outpatient and SUD outpatient, residential SUD/MH/COD facilities, residential severe mental illness (SMIs) organizations (IRTS facilities). Proven success in training, building, training and leading admissions departments, training clinical staff (counselors/therapists) in their role-pertinent aspects of insurance ASAM coding, DAANES, and EHR systems, and ensuring medical necessity compliance (ASAM, ICD-10, etc.).

Graduate training in clinical assessment (LPCC/LADC track) paired with hands-on experience in psychiatric stabilization, mental health counseling, and substance use disorder treatment at all levels of care and in a diversity of roles. I have proudly been recognized for my high standards in patient care and building rapport with them that places the patients and their loved ones as ease. I have always been ambitious, hard-working and driven and my performance reviews have often made note of my innovative thinking and creative solutions to problems, “infectious positive mindset” and ability to clear-headedly problem-solve under pressure. Currently, I am seeking a role that bridges operations and client care to deliver equitable, efficient access to treatment.

EDUCATION

University of Minnesota – Twin Cities

M.A., Integrated Behavioral Health (LPCC/LADC track) — *On Leave (2025–Present) *

• Graduate coursework in clinical assessment, substance use treatment, and evidence-based interventions.

B.A., Psychology — Graduated 2021

Lane Community College

A.A., Psychology —Graduated 2019—Transferred to U of MN-TC

CORE SKILLS

Clinical Experience and Core Skills

- Biopsychosocial & Diagnostic Assessments, C-SSRS, SBIRT, PHQ-9

- Evidence-Based Modalities: CBT, DBT, MI, ACT, CM, MAT

- Group & Individual Therapy; Treatment & Discharge Planning

- High-acuity settings: IRTS, Detox, Residential, PHP, IOP, OP

Behavioral Health & Clinical Services

- Biopsychosocial Assessments, Mental Status Exams, Risk Assessments (e.g., C-SSRS)

- Clinical Screenings: AUDIT, DAST-10, PHQ-9, GAIN-SS, SBIRT, CAGE, CRAFFT

- Treatment Planning: Individualized Tx Plans, Progress Notes, Discharge Summaries

- Evidence-Based Modalities: CBT, DBT, MI, ACT, CM, MAT

- Group & Individual Therapy; Family Sessions; Goal Setting and Client Engagement

- Levels of Care: Inpatient, Residential, PHP, IOP, OP, IRTS, Detox, Community-Based

Administrative & Operational Expertise

- Insurance Verification & Prior Authorization (Prospective, Concurrent, Retrospective)

- Utilization Review, Peer-to-Peer Reviews, ASAM Criteria, ICD-10, Medical Necessity Standards

- Denial Management, Appeals, Single Case Agreements, Authorization Justifications

- Patient Intake & Scheduling; Admissions Coordination; Care Transitions

- HIPAA Compliance; Clinical Documentation Accuracy; DAANES Fluency

Clinical Populations & Conditions

- Co-Occurring Disorders (SMI + SUD), Neurodevelopmental Disorders, TBI

- Personality Disorders, Mood & Anxiety Disorders, Schizophrenia, PTSD, OCD

- Eating Disorders, ADHD, Sleep Disorders, Conduct Disorders

- Trauma-Informed Care & Crisis De-escalation

Insurance & Utilization Review

- Prior Authorizations, Eligibility & Benefits Verification

- Peer-to-Peer Reviews, ASAM Criteria, ICD-10, Medical Necessity

- Denial Management, Appeals, Single Case Agreements

Systems & Software Proficiency

-EHR Super User: EPIC, Alleva, Procentive, Cerner, BestNotes,, etc.

-HIPAA Compliance, Billing Workflows, Credentialing & Contracting

-Environment of Care Inspections (Joint Commission compliance)

-PM & Workflow Tools: AdvancedMD, CollabMD, Salesforce, Compass, Epic, etc.

-Insurance Portals: Availity Plus and all other payer-specific portals

- VerifyTx, pVerify, MN-ITS, other Medicaid (WI and MN) portals

-EHR Super User experience (2x) – training & implementation support.

Leadership & Team Collaboration

- Staff Training & Supervision (Admissions, Behavioral Techs, Clinical Admin Teams)

- Cross-Department Collaboration with Medical, Clinical, Insurance, and Billing Teams

- Community Outreach, Referral Building, and Interagency Partnerships

- Regulatory Compliance (MN 245D, Joint Commission, Medicaid Standards

CERTIFICATIONS & CREDENTIALS

Mandt System 2.0 (Behavioral Crisis Training)

CPR, AED, First Aid (Current)

MN DHS Vulnerable Adult Certification

Prior Authorization Best Practices (2023)

Valid driver’s license; clear background; DOT-compliant

RESEARCH EXPERIENCE

Research Assistant – 2023 Midwest Climate Resilience Conference - University of Minnesota

•Collected, analyzed, and presented data on the intersection of climate change and mental health.

•Contributed to cross-disciplinary research on equitable adaptation, climate-related trauma, and community resilience.

•Responsible for organizing and analyzing data and crafting it into a presentation.

•Co-presented findings at the 2023 Duluth Symposium, developing skills in data visualization, presenting, networking, public speaking, and collaborative analysis.

EMPLOYMENT HISTORY

Client Administrative Coordinator – Outpatient Services

Hazelden Betty Ford Foundation – Saint Paul, MN / Hudson, WI

Mar 2025 – Present

Coordinate daily clinic operations across outpatient mental health and substance use services, ensuring seamless scheduling of psychiatric assessments, individual therapy, and group sessions.

Serve as primary liaison between psychiatric providers and patients, managing calendars, appointment logistics, and care coordination.

Oversee site inventory and procurement; manage all supply ordering, invoice reconciliation, and budget alignment with Accounts Payable.

Support psychiatric medication processes by managing lab orders, UDS/BAC testing, ROI documentation, and external medical record requests.

Maintain compliance with HIPAA, Joint Commission standards, and organizational policies through documentation audits and daily safety inspections.

Conduct Environment of Care (EOC) audits and ensure timely upload of reports to compliance platform (Compass).

Selected as a “Super User” during new EHR implementation—trained colleagues across multiple HBFF sites and provided go-live technical support.

Represent the organization at local events and community forums, supporting outreach and building relationships with referral sources during new site launch.

Mental Health Professional (MHP)

Gateway Health Services – Burnsville, MN

Nov 2024 – Mar 2025

Provided therapeutic support to adults experiencing acute psychiatric crises and co-occurring substance use disorders in a high-acuity IRTS facility.

Facilitated individual and group therapy sessions using evidence-based approaches (CBT, MI, DBT), and conducted clinical assessments to inform treatment planning.

Collaborated with a multidisciplinary care team to develop person-centered care plans focused on stabilization, skill-building, and recovery.

Fostered therapeutic rapport with clients navigating complex behavioral health challenges, promoting engagement and client-led goal setting.

Maintained comprehensive, timely clinical documentation in accordance with DHS standards and facility protocols.

Supported clients in life-skills development and safety planning, contributing to positive transitions to lower levels of care.

Admissions Director & Utilization Review Manager

Abria Detox/Abria Recovery – Burnsville/Lakeville, MN

Mar 2024 – Nov 2024

Launched the admissions department from the ground up, developing and implementing streamlined workflows, intake procedures, and documentation protocols.

Trained and supervised a team of 4 admissions staff, increasing efficiency and reducing intake errors.

Secured payer contracts with major commercial and Medicaid insurance providers across MN.

Conducted clinical reviews and utilization management, achieving a >95% approval rate for coverage through strong justifications and payer engagement.

Managed over 300 client intakes within the first 90 days, collaborating with families, referral partners, and clinical teams to ensure timely, appropriate placement.

Spearheaded appeals and single-case agreement processes, reducing denial rates and increasing reimbursement.

Admissions Coordinator

Burkwood Treatment Center – Hudson, WI

Oct 2022 – Jan 2024

Served as the first point of contact for clients and families, conducting pre-admission assessments aligned with ASAM and ICD-10 criteria to determine clinical appropriateness.

Built immediate rapport with clients and families, offering guidance and reassurance during vulnerable stages of the treatment process.

Navigated insurance systems to secure prior authorizations, increasing approval rates and reducing reimbursement delays.

Collaborated with clinicians, case managers, probation officers, and medical providers to streamline complex admissions.

Spearheaded outreach initiatives that increased program enrollment by 20%, consistently maintaining census levels above 85% capacity.

Facilitated smooth transitions across levels of care by coordinating intake, documentation, and clinical hand-offs.

Program Director (Promoted from Behavior Technician)

Howry Residential Services – Twin Cities, MN

Jun 2020 – Jul 2022

Behavior Technician (Jun 2020 – Jun 2021)

Provided direct care and behavioral support to individuals with developmental disabilities, traumatic brain injuries, and serious mental illness in residential settings.

Assisted clients with activities of daily living (ADLs), medication management, and community integration.

Built strong therapeutic rapport, helping reduce behavioral incidents and improve clients’ quality of life.

Collaborated with interdisciplinary care teams and documented progress using Therap software.

Program Director (Jun 2021 – Jul 2022)

Promoted to lead operations of a high-acuity group home serving clients with neurodevelopmental and psychiatric disorders.

Supervised and trained a team of Behavioral Health Technicians, optimizing schedules and improving shift coverage and team morale.

Developed individualized treatment and behavior support plans in collaboration with clinical teams, guardians, and county case managers.

Ensured regulatory compliance with MN 245D licensing standards and improved behavioral outcomes through staff coaching and client-centered interventions.

Oversaw budgeting, resource allocation, and environmental safety, maintaining program integrity and financial accountability.

Personal Support Worker

Lane County Department of Health & Human Services – Eugene, OR

Jan 2016 – Jul 2019

Provided in-home behavioral support to children with autism spectrum disorder (ASD), implementing care plans designed in coordination with therapists and families.

Conducted functional assessments to identify developmental needs and inform individualized treatment goals.

Created and executed weekly behavioral goal plans, resulting in measurable improvements in communication, emotional regulation, and daily functioning.

Coordinated services across families, schools, and therapy teams to ensure continuity of care and successful intervention outcomes.

Facilitated therapeutic play and skill-building activities to foster engagement and promote developmental milestones.

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