Authorization Specialist II - Utilization Management Expert
Resume:
Terrie Hudson
Authorization Specialist II
Casar, NC 28020
***********@*****.***
Professional Summary
Detail-oriented Utilization Management Specialist with 10 years of experience in healthcare administration, specializing in pre-authorization processes and insurance verification. Proven track record of collaborating with healthcare providers to ensure compliance and timely patient care. Strong leadership skills demonstrated through coordination of referral processes and patient management in high-volume settings. Certified Medical Assistant with expertise in electronic health records and HIPAA compliance, dedicated to enhancing patient experiences and operational efficiency. Authorized to work in the US for any employer
Work Experience
Utilization Management Specialist II
Centene Corp.-Saint Louis, MI
March 2025 to Present
• Reviewed and processed pre-authorization requests for medical procedures, ensuring compliance with insurance guidelines
• Verified patient eligibility and benefits coverage to determine if pre-authorization was required
• Collaborated with healthcare providers to obtain necessary documentation and clinical information for pre-authorization requests
• Maintained accurate records of all pre-authorization activities in the electronic database Precertification Specialist
Frye Care Cardiology-Hickory, NC
November 2023 to November 2024
• Reviewed and processed pre-authorization requests for medical procedures, ensuring compliance with insurance guidelines
• Verified patient eligibility and benefits coverage to determine if pre-authorization was required
• Maintained accurate records of all pre-authorization activities in the electronic database
• Resolved issues related to incomplete or inaccurate documentation by coordinating with healthcare providers and insurance companies
• Developed strong knowledge of different insurance plans, policies, and procedures related to pre- authorizations
• Assisted patients in understanding their insurance coverage and explained the process of obtaining a pre-authorization
• Ensured timely submission of complete and accurate pre-authorization requests to minimize delays in patient care
• Managed a high volume of incoming calls from patients, healthcare providers, and insurance representatives regarding pre-authorizations
Patient Service Representative /CMA New Patient Coordinator/ Electrophysiology Scheduling Coordinator
Fryecare Cardiology-Hickory, NC
June 2021 to November 2023
• Managed and coordinated all aspects of the referral process for a busy medical practice
• Reviewed patient records to determine appropriate referrals based on medical necessity and insurance requirements
• Communicated with patients, healthcare providers, and insurance companies to obtain necessary information for referrals
• Ensured timely submission of referral requests to specialists or other healthcare facilities
• Followed up on pending referrals to ensure completion within designated timeframes
• Maintained accurate and organized referral documentation in electronic health record system
• Collaborated with physicians and clinical staff to develop comprehensive care plans for patients requiring specialized services
• Coordinated communication between primary care providers and specialists to facilitate continuity of care
• Assisted in obtaining prior authorizations from insurance companies for specialty procedures or treatments
Customer Service Representative
Concentrix-Hickory, NC
October 2020 to June 2021
• Provided exceptional customer service by promptly addressing inquiries, resolving issues, and ensuring customer satisfaction
• Managed a high volume of incoming calls and emails, consistently meeting or exceeding performance metrics for response time and resolution
• Demonstrated strong product knowledge to effectively answer customer questions and provide accurate information
• Maintained detailed records of all customer interactions in CRM system for future reference and analysis
• Collaborated with cross-functional teams to escalate unresolved issues and ensure timely resolution for customers
Check-in Agent
PAIN RELIEF CENTERS-Hickory, NC
July 2020 to October 2020
• Greeted and checked in patients, ensuring a positive and welcoming experience upon arrival
• Scheduled appointments for patients, efficiently managing the appointment calendar to minimize wait times
• Verified patient insurance information and collected co-pays, streamlining the billing process
• Answered phone calls and addressed inquiries or directed them to the appropriate department or staff member
• Maintained patient records by accurately updating personal information, medical history, and treatment plans in electronic health record system
• Managed incoming and outgoing mail, distributing correspondence to the appropriate recipients
• Assisted with administrative tasks such as filing documents, organizing paperwork, and maintaining office supplies inventory
• Collaborated with healthcare providers to ensure timely communication of test results or other important information to patients
Cellular Sales
PLANET WIRELESS-Hickory, NC
January 2018 to January 2020
• Built and maintained a loyal customer base, resulting in a high rate of repeat business
• Provided exceptional customer service by actively listening to customers' needs and recommending appropriate products and services
• Demonstrated expertise in the features and benefits of various cellular devices, plans, and accessories to assist customers in making informed purchasing decisions
• Effectively handled customer inquiries, complaints, and returns with professionalism and efficiency
• Collaborated with team members to achieve overall store sales goals while maintaining a positive work environment
• Stayed up-to-date on industry trends, new product releases, and competitor offerings to provide accurate information to customers
• Assisted in inventory management by conducting regular stock checks, identifying popular items for reordering, and ensuring adequate product availability at all times Scheduling Coordinator/ CNA II
Burke Hospice & Palliative Care-Valdese, NC
March 2016 to January 2018
• Coordinated and scheduled appointments, meetings, and events for multiple departments within the organization
• Collaborated with managers to create optimized schedules that met both employee availability and business needs
• Monitored and adjusted schedules in real-time to accommodate changes or emergencies
• Maintained accurate records of all scheduled activities, including cancellations and rescheduling
• Communicated schedule updates to relevant parties in a timely manner to ensure smooth operations
• Resolved conflicts or issues related to scheduling conflicts promptly and effectively
• Implemented automated scheduling software/systems to improve efficiency and accuracy
• Tracked attendance records for employees, identifying patterns or issues that required attention
• Generated reports on employee productivity based on scheduled hours versus actual hours worked
• Ensured compliance with company policies regarding breaks, overtime, and time-off requests when creating schedules
Specimen Collector
Dominion Diagnostics/All medical Personnel-Hickory, NC July 2015 to February 2016
• Collected, labeled, and prepared patient specimens for laboratory testing
• Performed quality control checks on equipment and reagents to ensure accurate test results
• Maintained inventory of supplies and ordered new materials as needed
• Followed standard operating procedures (SOPs) to handle and dispose of hazardous materials safely
• Collaborated with healthcare professionals to prioritize specimen collection based on urgency and patient needs
• Calibrated and maintained laboratory equipment to ensure accuracy in test results
• Processed specimens according to established protocols, ensuring timely delivery of results Emergency Room Technician
Carolinas Healthcare System/ Atrium Health-Lincolnton, NC August 2014 to August 2015
• Provided immediate medical assistance to patients in the emergency room, including performing vital signs assessments and administering basic first aid
• Assisted physicians and nurses with various medical procedures such as wound care, splinting, and suturing
• Monitored patient condition and reported any changes or concerns to the healthcare team
• Operated and maintained medical equipment such as EKG machines, defibrillators, and oxygen tanks
• Ensured a clean and safe environment for patients by properly disposing of hazardous materials and maintaining infection control protocols
• Collaborated with other healthcare professionals to coordinate patient care plans and ensure efficient workflow in the ER department
• Managed patient flow by prioritizing cases based on severity of condition, ensuring timely treatment for critical patients
Customer Service Representative
Ameridal Call Center-Spindale, NC
March 2014 to August 2014
• Provided exceptional customer service by promptly addressing inquiries, resolving issues, and ensuring customer satisfaction
• Managed a high volume of incoming calls and emails, consistently meeting or exceeding performance metrics for response time and resolution
• Demonstrated strong product knowledge to effectively answer customer questions and provide accurate information
• Built rapport with customers through active listening, empathy, and personalized interactions
• Resolved complex customer complaints by investigating the root cause of the issue and implementing appropriate solutions
• Assisted customers in navigating company website, troubleshooting technical issues, and placing orders online
• Collaborated with cross-functional teams to escalate unresolved issues and ensure timely resolution for customers
Certified Nursing Assistant (CNA)/ Scheduling Coordinator Burke Hospice & Palliative Care-Valdese, NC
March 2010 to January 2014
Provided daily care for patients in the Inpatient Hospice facility
• Provided compassionate and personalized care to terminally ill patients in a hospice setting
• Assisted with activities of daily living, including bathing, dressing, grooming, and toileting
• Administered medications as prescribed by healthcare professionals and documented patient responses
• Monitored vital signs regularly and reported any changes or concerns to the nursing staff
• Ensured a clean and safe environment for patients by maintaining cleanliness and infection control protocols
• Supported emotional well-being of patients by actively listening, providing companionship, and offering comfort during difficult times
• Collaborated with interdisciplinary team members to develop individualized care plans for each patient
• Assisted in end-of-life care procedures such as turning/repositioning bedridden patients to prevent pressure ulcers
• Provided assistance with pain management techniques under the guidance of healthcare professionals
• Documented patient observations accurately in medical records to ensure continuity of care among different shifts
• Communicated effectively with patients' families regarding their loved ones' condition, progress, and needs for support services
• Responded promptly to emergency situations or calls from patients requiring immediate attention Certified Nursing Assistant (CNA)
College Pines Nursing & Rehab-Valdese, NC
August 2009 to January 2010
• Provided compassionate and personalized care to patients, ensuring their comfort and well-being
• Assisted with daily activities such as bathing, dressing, grooming, and feeding
• Monitored vital signs including blood pressure, pulse rate, temperature, and oxygen levels
• Administered medications accurately following prescribed guidelines
• Maintained accurate patient records and documented any changes in condition or behavior
• Collaborated with healthcare team members to develop and implement individualized care plans
• Responded promptly to patient calls for assistance and provided immediate support as needed
• Assisted in transferring patients safely between beds, wheelchairs, stretchers, or other medical equipment
Certified Nursing Assistant
Sunrise Rehab & Care-Nebo, NC
December 2008 to June 2009
• Provided direct patient care, including assisting with activities of daily living such as bathing, grooming, and dressing
• Monitored vital signs and reported any changes or abnormalities to the nursing staff
• Assisted in transferring patients from beds to wheelchairs or other mobility devices
• Administered medications under the supervision of a registered nurse or licensed practical nurse
• Maintained accurate documentation of patient care activities and observations
• Ensured a clean and safe environment for patients by maintaining cleanliness in patient rooms and common areas
• Assisted with feeding patients who required assistance or had special dietary needs
• Provided emotional support to patients and their families during difficult times
• Responded promptly to call lights and requests for assistance from patients Education
Certified Medical Assistant (CCMA)
WNC Edutech-Columbus, NC
January 2022 to April 2022
Healthcare Administration (Associate's Degree)
Colorado Tech Online-Colorado Springs, CO
February 2012 to June 2016
Anatomy
Physiology
Healthcare Administration (Certificate Phlebotomy) Western Piedmont Community College-Morganton, NC
2008 to 2008
EKG Tech
CNA II
GED
Cleveland Community College-Shelby, NC
August 2007 to November 2007
Skills
• Hospital experience
• Insurance Verification
• Mobile devices
• Writing skills
• HIPAA compliance management
• Rehabilitation center experience
• Utilization review
• Medical Records
• Records management
• Microsoft Excel
• Surgery
• Working with people with disabilities
• Excel data analysis
• Computer hardware
• iOS
• Salesforce Cloud
• Ethernet
• Grammar Experience
• Leadership
• Health insurance knowledge
• Software troubleshooting
• Clerical Experience
• Direct sales
• Insurance claim appeals processing
• Healthcare compliance
• Technical support
• Patient education
• Root cause analysis
• Experience with children
• Medical administrative support - Medical administrative support experience (6-10 years)
• SharePoint
• CRM software
• Windows
• Working with people with developmental disabilities
• Evidence-based interventions in treatment planning
• Medical assisting
• Mobile applications
• State healthcare regulations
• ICD-10
• Appeals
• Community care (work setting)
• Behavior intervention
• Social media management
• Child protective services
• Schedule management
• Customer Service
• HIPAA
• Medical Coding
• Urgent care
• Medical scheduling
• Discharge planning
• Medical claims processing
• Research
• Inventory control
• Continuous improvement
• Patient assessment
• Word processing
• Appointment scheduling
• Adobe Acrobat
• Training
• Task prioritization
• Quality Assurance
• Hospice experience
• Experience with individuals with neurodevelopmental disorders
• Medical Office Experience
• Google Workspace
• Venipuncture
• Microsoft Outlook
• Achieving HIPAA compliance
• ADP
• Private practice experience
• IT
• Documentation review
• Phone etiquette
• Courier
• Radiology
• Pharmacy technician experience
• Multi-line phone systems
• Dispatching
• Progress documentation
• EXCEL
• Family medicine
• Pricing
• Report writing
• QuickBooks
• Senior care
• Computer Operation
• CRM system proficiency
• Experience Administering Injections
• Vital signs
• English
• Filing
• Patient interaction
• Assembly
• Medical insurance coverage verification
• Phlebotomy
• Care plans
• Referral coordination
• Telehealth
• Salesforce
• Allied health - Allied health experience (3-5 years)
• POS
• Medical insurance appeals management
• Computer literacy
• Behavioral health
• Data entry
• Experience with individuals with mental health conditions
• Telecommunication
• Microsoft Teams
• Clinical confidentiality policies
• Google Ads
• Patient consultations
• Medical imaging
• Home care experience
• Inside sales
• Revenue cycle management
• Home health agency experience
• Electronic health records (EHR) management
• NextGen
• Patient registration
• Account management
• Insurance prior authorization
• Slack
• EMR Systems
• Organizational skills
• Telemarketing
• Health education and counseling
• Anatomy Knowledge
• Direct support
• Care coordination
• Public relations
• Live chat
• Medical equipment operation
• DME
• Collecting samples for laboratory testing
• Phone communication
• Client services
• Community resource coordination
• Conducting sales calls
• Customer support
• Substance abuse
• Patient management in an allied health role - Largest number of patients managed monthly in an allied health role (76-100 patients)
• Computer Skills
• Client interaction via phone calls
• Home Care
• Food preparation
• Microsoft Word
• Social media platforms
• Productivity software
• Epic
• iCIMS
• Clinic
• Laboratory experience
• Athenahealth
• Microsoft Office
• Physiology Knowledge
• Call center experience
• Ambulatory surgery center experience
• Triage
• Analysis skills
• B2B sales
• Time management
• ERP systems
• CPT Coding
• Cerner
• Kronos
• Hospice & palliative medicine
• Computer networking
• Office management
• Marketing
• Mac OS
• Outpatient
• Microsoft Access
• eClinicalWorks
• Hospice Care
• FMLA
• Oncology
• AI
• Handling patient inquiries
• OR experience
• Experience with individuals with cognitive disabilities
• EMR/EHR
• Medical software
• Negotiation
• Medical payment processing
• ICD-9
• Maintaining patient confidentiality
• Search engines
• Experience with individuals with substance use disorders
• Production planning
• Clinical documentation
• Databases
• Working with children
• Employee orientation
• Zoom
• Home health
• Heavy lifting
• Crisis intervention counseling
• Product demos
• Order entry
• Conflict management
• Dependability
• Meal preparation
• Medical terminology
• Workday
• Patient Care
• Nursing home experience
• Accounting
• Managing patient records
• Availity
• Clinic experience
• Communication skills
• Production scheduling
• Presentation skills
• Technical Proficiency
Certifications and Licenses
Certified Medical Assistant (AAMA)
April 2022 to April 2026
Cardiology office PSR/CMA
Additional Information
Computer and Technical Skills
• Microsoft Word
• Microsoft Office
• Microsoft Power Point
• Excel
• Types 40 Word per Minute
• First Net
• Star
• Athena
• Authnet
• eClinical Works
• Epic
• Cerner
• Allscripts
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