Utilization Review Coordinator Resume Guide

Passionate utilization review coordinator with 8+ years of experience managing utilization and evidence-based care. Experienced in developing clinical guidelines for payers, providers, and community organizations to ensure compliance with applicable regulations. At XYZ Health System, reduced staff overtime by 25% using creative scheduling solutions while ensuring quality care was maintained. Successfully applied process improvement methods to increase efficiency and improve patient outcomes.

Enthusiastic utilization review coordinator with 8+ years of experience in the healthcare industry. Skilled at managing clinical records, conducting utilization reviews and audits, and ensuring compliance with applicable regulations. At XYZ Hospital, reduced denials by 15% through timely follow-up on requests for medical documentation from third-party payors. Effectively managed 50 concurrent cases while maintaining a high standard of accuracy and quality assurance.

Amicable Utilization Review Coordinator with 8+ years of experience in healthcare operations. At XYZ Hospital, managed the utilization review program for up to 100 patients per day and maintained documentation accuracy rates at 99%. Adept at using data analysis techniques to identify trends and make recommendations for process improvement initiatives. Recognized by leadership as a subject matter expert on insurance regulations & reimbursement models.

Professional utilization review coordinator with 7+ years of experience in the healthcare industry. Highly skilled at managing utilization reviews for patients, assessing health records and data, verifying insurance coverage and eligibility requirements, and interpreting medical codes for billing purposes. Seeking to join ABC Medical Center as a Utilization Review Coordinator where I can continue to provide excellent patient care services.

Hard-working utilization review coordinator with 5+ years of experience in utilization management, care coordination and quality assurance. Proven success in managing a high-volume caseload for ABC Medical Group while ensuring compliance with all regulatory requirements. Demonstrated ability to analyze data, develop reports and provide recommendations on cost reduction strategies that achieved an average savings of 17% per case.

Reliable and detail-oriented Utilization Review Coordinator with 4+ years of experience working in both the medical and insurance fields. Skilled at facilitating seamless transitions between insurance companies, providers, patients, and families to ensure optimal utilization of resources. Experienced in managing complex cases involving multiple parties while providing excellent customer service throughout the process.

Accomplished utilization review coordinator with 3+ years of experience in reviewing and approving healthcare services for a variety of clients. Proven track record of accurately managing patient cases, consistently meeting regulatory requirements, and ensuring high-quality care. Looking to join ABC Healthcare as an UR Coordinator to bring my extensive knowledge and expertise to the team.

Seasoned Utilization Review Coordinator with 6+ years of experience in the healthcare industry. Expertise in utilization management and clinical coding, as well as a proficiency in gathering data for quality improvement initiatives. Seeking to join ABC Medical Center to leverage strong communication and organizational skills to ensure compliance with payer requirements.

• Advocated on behalf of patients with insurance providers to ensure appropriate utilization review coverage, resulting in securing over $250K in approved reimbursements.
• Developed and implemented a comprehensive intake process which included pre-authorization reviews for potential medical services, reducing unnecessary care by 10%.
• Resolved any discrepancies or disputes between patient claims and health plan benefits through thorough research and evaluation; maintained accurate records of all communication between parties involved.
• Achieved significant cost savings for clients by effectively negotiating payment terms on their behalf with providers; reduced average payments per claim from $1,500 to $750 over the course of one year.
• Confidently identified areas that needed improvement within existing utilization processes while working closely with other departments such as billing & collections, compliance & risk management teams for successful outcomes.

• Mentored and trained a team of five Utilization Review Coordinators to effectively review medical records and documentation, resulting in a 30% increase in productivity.
• Spearheaded efforts to implement an electronic system for utilization reviews that reduced errors by 40%, improved accuracy by 25%, and lowered processing time from 3 days to 2 hours per case.
• Substantially increased the number of successful appeals on denied claims from 20% to 60%; saved over $250K annually in rejected reimbursements due to my accurate analysis of cases.
• Monitored incoming requests for utilization reviews on a daily basis; responded quickly and efficiently within 24 hours or less while meeting all departmental performance standards 100%.
• Researched best practice guidelines for utilization review procedures, helping our team become compliant with new legislation changes related to health insurance policy regulations and reimbursement strategies.

• Processed over 300 utilization reviews and prior authorization requests daily, ensuring that the correct level of care was delivered to patients while remaining compliant with federal regulations.
• Successfully reduced denials by 10%, resulting in savings of $50K and improved data accuracy for over 200 health plans within 6 months.
• Optimized existing processes through analysis of claims data, provider contracts & reimbursement policies; identified opportunities where reimbursements could be increased by 15%.
• Demonstrated excellent communication skills when interacting with physicians, customers & insurance companies; resolved discrepancies between patient records & payment information quickly and efficiently.
• Reconciled complex billing disputes involving multiple parties on a weekly basis, recovering an average of $25K per month for the organization from denied or incorrectly billed services/claims.

• Documented utilization review data for over 200 insurance claims daily, ensuring accuracy of all patient records and resulting in a 95% reduction in errors.
• Structured utilization protocols to increase efficiency and reduce healthcare costs by $15,000 each quarter without compromising medical quality standards.
• Competently managed relationships with physicians and other providers to ensure timely completion of authorization requests; expedited turnaround times from 10 days on average to 5 days or less per request.
• Coordinated support services such as pre-authorization reviews, concurrent reviews, discharge planning & appeals management while maintaining compliance with Medicare/Medicaid regulations at all times.
• Expedited the transition process between care settings by proactively communicating with patients’ families regarding pending referrals or transfers; reduced wait time for hospital admission decisions by 40%.

• Facilitated utilization review of over 500 patient cases per month, ensuring that all processes were completed in an efficient and timely manner.
• Thoroughly examined medical records and other documentation to identify any potential discrepancies or issues with the care plan; reduced denials by 40%.
• Improved upon existing utilization review protocols by developing new guidelines for pre-authorizations, appeals and discharge planning, resulting in a 15% increase in successful claims processing rates from insurers.
• Advised healthcare providers on appropriate treatment plans according to insurance coverage requirements while maintaining high quality standards; secured additional reimbursements worth $25K weekly through proactive negotiations with payers & employers’ benefits departments.
• Analyzed health data trends (including cost analysis) from multiple sources to uncover opportunities for improved efficiency within the organization’s utilization management practices; identified areas of improvement which resulted in savings amounting up to $300K annually.

• Utilized knowledge of insurance policies and applicable federal, state and local laws to review medical records for utilization management purposes; decreased turnaround time by 15%.
• Introduced new methods for assessing patient health care needs that resulted in a 10% reduction in unnecessary services over the course of one year.
• Prepared detailed reports outlining clinical indicators, diagnoses codes, treatment plans and other relevant information needed for authorization requests; processed over 200 reviews a month with 100% accuracy rate.
• Efficiently managed all coordination activities between providers regarding pre-certification requirements while facilitating appropriate communication within the healthcare team on behalf of patients.
• Reduced total cost per case by 8%, due to successful implementation of strategies designed to ensure maximum cost efficiency without compromising quality standards or service delivery timelines.

• Presented concise and accurate utilization review reports to management, demonstrating an improved medical cost savings of 15% in the last quarter.
• Proficiently audited insurance claims for compliance with company standards & regulations; identified errors in billing codes that resulted in a total financial reimbursement of $5,000 from 3rd party payers.
• Formulated policies and procedures for efficient utilization review processes while ensuring all activities were conducted within the scope of current health care laws and regulations.
• Reorganized existing data entry systems to improve accuracy when verifying patient eligibility information; reduced backlogs by 25%.
• Evaluated denials received from third-party payers against established criteria or accepted industry standards; achieved 100% success rate in overturning unjustified denials resulting in a consistent cash flow into the organization’s coffers over 6 months.

Bachelor’s Degree in Health Administration
Educational Institution XYZ
Nov 2011

Certified Utilization Review Coordinator (CURC)
American
May 2017