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Healthcare operations and quality professional with experience in utilization management, prior authorization review, provider spreadsheet error resolution, NOA processing, auth-related appeals support, claims validation, audits, SOP review, and state MCO contract compliance. Current B.S. Data Analytics building toward healthcare analytics and analytics-adjacent roles, with hands-on experience creating Excel-based workflow tools, reports, and tracking resources to improve accuracy, identify trends, and support operational decision-making.

Utilization Management Representative II - Elevance Health

(2024-12)

• Reviewed and approved prior authorizations by validating service details, date spans, provider information, and supporting documentation against internal procedures and state MCO contract requirements.
• Analyzed complex provider spreadsheets containing authorization errors, identify patterns and discrepancies, and coordinate corrections to support accurate authorizations and downstream billing.
• Designed and executed custom Excel scripts, macros, and automated tools to streamline daily authorization workflows, eliminating manual data entry tasks and reducing processing rework.
• Support department quality initiatives through team audits, exception reviews, root-cause analysis, SOP creation/review, and process improvement recommendations.
• Process/review NOAs, authorization-related appeals, and claims validation and error resolution to confirm whether services were billed before authorization updates or corrections are completed.
• Collaborated with provider relations, service coordinators, medical directors, and internal teams to resolve authorization issues, provide guidance on auth-entry expectations, and strengthen compliance-focused workflows.

Title & Registration Processor II - Acertus

(2023-02 - 2024-11)

• Managed high-volume vehicle title and registration transactions while ensuring compliance with state-specific documentation requirements.
• Reviewed legal transfer documents for accuracy, completeness, and missing information before submission to DMV offices and external partners.
• Researched documentation issues, coordinated corrections with vendors, dealers, and DMV contacts, and maintained accurate records in internal systems.

Quality Control Analyst - The Workforce Group

(2022-06 - 2022-08)

Temporary contract assignment

• Audited emergency rental assistance applications for accuracy, completeness, eligibility documentation, and program compliance.
• Validated application, claim, and payment information against program requirements and flagged discrepancies for correction or escalation.

Benefits Specialist - UnitedHealth Group

(2021-01 - 2022-05)

• Navigated multiple internal managed care systems simultaneously to resolve complex inbound inquiries from KanCare Medicaid members and healthcare providers under strict state-mandated SLAs.
• Checked member eligibility, verified insurance coverage, and cross-referenced KanCare benefit plans to resolve disputed claims and prior-authorization questions.
• Researched high-volume claim and benefit issues using healthcare customer tracking databases, documented actions accurately, and maintained strict HIPAA compliance throughout all interactions.

Administrative Assistant - PAE

(2017-02 - 2021-02)

• Scheduled citizenship interview appointments and maintained accurate applicant records in government systems.
• Reviewed applications and supporting records for accuracy, completeness, compliance, and confidential handling of sensitive information.

Bachelor of Science - Data Analytics - Southern New Hampshire University