Utilization Review Specialist
Resume:
TERESA MORILLA SMITH
**********@*****.***
FT. LAUDERDALE, FL 33313
OBJECTIVE
Seeking a position within a healthcare organization to utilize my experience in utilization review, patient care coordination, and medical billing. I am eager to expand my knowledge while contributing my expertise in healthcare operations and communication skills. SKILLS & ABILITIES
• Management: Experienced in healthcare coordination, patient communication, and team leadership.
• Communication: Strong interpersonal skills, proficient in-patient advocacy and liaison roles.
• Medical Billing and Coding: Proficient in ICD-9/ICD-10, CPT 4 coding, and medical reimbursement processes.
• Technical Skills: MED CARD, Epic (EMR), Verifone, Patcom, EMEVS, AV20K, Cerner. EXPERIENCE
08/2024- Present Utilization Review Specialist
Exact Billing Solutions- Autism ABA Centers of America Evaluate the appropriateness and efficiency of healthcare services to ensure patients receive the best care
Collaborate with medical staff, insurance representatives, and other clinical professionals to ensure effective care coordination. 08/2022-08/2024 Collections Specialist
IVF Florida Reproductive Associates
Managed assigned accounts, identified outstanding debts, and contacted debtors regarding payment status.
Planned and executed strategies to recover overdue payments while processing refunds and resolving billing issues.
Investigated historical data on debts and communicated with clients to encourage timely payment.
06/2022-08/2022 Referral Coordinator
MTI America
Assisted in the coordination of medical and psychosocial aspects of patient care and utilization.
Initiated authorization requests for services and coordinated communication between providers, members, and clinical staff. Verified eligibility, monitored inpatient census, and coordinated care transitions involving physicians, home health agencies, and medical providers.
04/2022-08/2022 Sales Representative
Infinity Sales Group
Handled inbound calls to provide home service solutions, recommending services based on customer needs and location.
Processed customer enrollments using the company’s CRM system and offered additional products based on availability. 04/2021-10/2021 Utilization Management Coordinator Affinity Health Plan
Assisted in managing authorization requests and updates in line with patient care plans.
Acted as a liaison between members, providers, and care teams, ensuring timely and effective communication.
Participated in case reviews and compliance activities to ensure authorization processes were followed.
03/2021-Present Home Health Aide
Life Care Advantage
Provided daily living assistance and managed medication regimens for a disabled family member.
Escorted patients to doctor’s appointments and personal errands while overseeing overall health.
08/2018-02/2021 Home Health Aide
Freedom Care
Assisted a disabled family member with activities of daily living and managed medical care coordination.
Accompanied to medical appointments and personal errands while ensuring adherence to health management routines.
02/2018-05/2018 Medical Clerical Associate
Mount Sinai Hospital
Worked in a high-volume call center, setting appointments for specialty clinics and verifying insurance information.
Relayed important messages to healthcare providers, ensuring efficient patient communication.
03/2015-02/2018 Paralegal/Secretary
Polanco & Associates
Supported attorneys by filing legal documents, maintaining records, and providing confidential administrative support.
Drafted invoices, collected fees, and handled client communication with discretion.
Managed office expenses, phone calls, emails, and letters related to various legal cases.
04/2001-11/2014 Ambulatory Care Representative
Jamaican Hospital
Registered incoming patients, verified insurance information, and coordinated referrals and authorizations in a high-volume clinic. Triaged phone calls and maintained health insurance statistics for the clinic.
References furnished upon request.
Contact this candidate