Sunshine Torres
Litchfield Park
Summary
Detail-oriented Utilization Management Coordinator with 18+ years of experience in managing pre-authorization processes for medical services and durable medical equipment. I am proficient in reviewing clinical documentation, ensuring compliance with insurance policies, and facilitating effective communication between healthcare providers and insurance companies to expedite approvals. I posses the ability to optimize workflows and enhance patient satisfaction through a commitment to accuracy and efficient problem resolution.
Demonstrates strong, communication, and teamwork skills, with proven ability to quickly adapt to new environments.
Overview
8
8
years of professional experience
Work History
Utilization Management Coordinator
MHM Healthcare
01.2018 - Current
My duties include but not limited to; Verify member eligibility, benefits, and other coverage. I review prepare and coordinate requests for completeness, include proper coding. I request additional supportive clinical documentation as needed. Process requests within Health Plan/ICE turn-around-times.
Forward misdirected requests to the heath plan when applicable. Assist Members/Provider with questions regarding authorization status. Follow IPA UM Guidelines when processing requests. Additionally, I enter all incoming referrals and assist in Letter of Agreement process while direct supervisor is away.
Education
High School Diploma -
Nueva Vista High School
Riverside, CA06-1993
Skills
- Intermediate knowledge of ICD/CPT/HCPCS coding
- Intermediate knowledge of Medical Terminology
- Knowledge of Medi-Cal guidelines, Provider Manual, benefits
- Skilled in Microsoft programs-Word, Excel and Outlook
Timeline
Utilization Management Coordinator
MHM Healthcare
01.2018 - Current
High School Diploma -
Nueva Vista High School