Utilization Management & Insurance Support Specialist

706-***-**** *******.******@*****.***

Amber N. Bass

Professional Summary

Detail oriented Utilization Management and Insurance Support Professional with 6 years of experience in healthcare operations, customer service, and claims processing. Skilled in verifying benefit eligibility, coordinating prior authorizations, and supporting clinical teams to ensure timely and accurate care approvals. Proven ability to manage high volume inquiries (average 50-60 calls/cases daily), resolve complex member and provider issues, and maintain compliance with insurance and organizational standards.

Education and Relevant Training

2020-2026 Elevance Health Work Ethics, Policies & Procedures

2016 Easter Seals CPR Certification

2014 Columbus Technical College Child Development Specialist Certification

Summary of Qualifications

●Proficient in utilizing health insurance operational systems to support claims processing, eligibility verification, and secure access to patient and provider information, including:

Citrix (Internal Member Profiles/Accounts)

Availity (Member Website for Precertification Recommendation)

ASPEN (eligibility verification, create authorizations)

ACMS (verify members and review previous cases, create new cases)

Mainframe and Ompta (CPT Code Descriptions)

NPI Registry (viewing/verifying Physician and Facility Provider Information)

●Proficient in Microsoft Teams, Teams Meetings, Gmail, Google Meet, Microsoft Outlook, CoPilot, ChatGPT

●Five years of Training Facilitation experience for new hires and new systems

●Eight years of experience documenting follow up notes for student progress reports, as well as patient/member recommendations and authorizations within educational and health system settings

●Seven years of customer service support experience within a call center setting, both in person and remote

Work Experience

2023 - 2026 Elevance Health Utilization Management Representative II Midland, GA

●Received a high volume of incoming calls and written requests from members and providers related to post-service claim needs, including responding to inquiries from clients, in-house departments

●Prepared and maintained comprehensive case update documentation within the health system, ensuring client/member file accuracy, up to date, and compliant with organizational standards

●Determined contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests

●Referred cases requiring clinical review to Nurse Reviewers

●Responsible for the identification and data entry of referral requests into ASPEN and ACMS systems in accordance with the insurance plan certificate to include confirming benefits for facility-based treatment

●Provided training to new hires on various health insurance operational systems

2020 - 2023 Elevance Health Utilization Management Representative I Midland, GA

●Received a high volume of incoming calls and written requests from members and providers related to post-service claim needs, including responding to inquiries from clients, in-house departments

●Determined contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests

●Responsible for the identification and data entry of referral requests into ASPEN and ACMS systems in accordance with the insurance plan certificate to include confirming benefits for facility-based treatment

2018 - 2020 Global Payment (formerly TSYS) Customer Service Specialist

Columbus, GA

●Reviewed and received credit card payments from cardholders

●Investigated charges and fee requests from cardholders

●Assist customers in completing credit card applications

●Responded to customer inquiries via telephone, email, SMS and Chat to provide problem resolution in accordance with the organization’s service standards

2015 - 2018 Easterseals West Georgia Teacher and Classroom Coordinator Columbus, GA

●Creating, planning, teaching, and implementing curriculum designed to enhance the physical and mental development of children with disabilities and special needs

●Prepared detailed student progress reports for distribution to parents and educational staff for Parent-Teacher Conferences and Administration Meetings

●Attend in-service and staff development training programs, such as CPR and First Aid Training

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