Utilization Review Technician Resume

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Contact Information:

Full name

Present and permanent addresses

Telephone numbers

Email address

Objective:

Seeking an upper-level position with responsibilities including problem solving, planning, organizing, and research.

Education:

• Completed Pharmacy Technician Program, 2003, Virginia Highlands Comm. College, Abingdon, VA
• Associate Degree in Biology/Pre-Med, 2001, Concord (College) University, Athens, WV

Technical Skills:

• Familiar with ICD-9 and DSM-IV coding for medical/psychiatric diagnoses
• Windows Operating Systems, Lotus Notes and Outlook Express email clients

Accreditations and Certifications:

• Virginia certified EMT-Intermediate/Cardiac-Technician
• Member of Alpha Phi Omega co-ed service fraternity, as well as served as Committee chair for the 2001 APO Annual Conference

Experience:

Universal Health Services / Keystone Marion November 2004 – Present

Utilization Review Coordinator/Medical Records

• Increased pre-authorizations from 0% Virginia Medicaid reimbursement to 100%, and have maintained 100% reimbursement rate of medically necessary residential stays, meeting strict and costly Medicaid deadlines in a timely, consistent manner.
• Have responded to requests for additional information, denials, pends and appeals.
• Devised organizational methods to maintain Utilization Review records in the event of an audit or appeal.

Abindon Ambulance Service, Abingdon, VAJuly 2001 – October 2004

Billing Clerk/EMT-Cardiac Technician

• Billed all major and commercial primary insurers using CMA HCFA-1500 forms via postal mail and via electronic billing means, utilizing ICD-9 and CPT coding.
• Processed denials, pends and requests for additional information from insurance companies by interpreting denial codes and reasons set forth by insurance companies, as well as participated in the appeals process.
• Responded to customer and patient concerns and questions with ability to assist in interpreting and explaining EOBs via telephone, as well as determining estimated co-pays and balances due.

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