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A self-motivated and organized professional with over 13 years experience in the Healthcare Insurance industry.  Highly effective at multitasking in a fast-paced environment; able to prioritize effectively to accomplish objectives accurately and timely.

Work experience

Jul 2012Oct 2015

Quality Improvement Specialist

Anthem Inc.
Jun 2009Jul 2012

Clinical Operations Specialist

Anthem Inc.
  • Help develop and implement the Provider Engagement/Enabler Pilot Program
  • Help develop and initiate team pods for CKD/ESRD Senior Initiatives
  • Crosstrain my peers on Rightfax, Filenet, SharePoint, WMDS, CCB
  • Assist with auditing offshore staff
  • Contact providers to load case so it can be handled in a timely manner
  • Handled the final scrub of the TAT reports to ensure compliance is maintained and brought any issues to the Team Lead
Sep 2006Jun 2009

Customer Service Rep III

Filenet, SharePoint, WMDS, CCB
Crosstrain my peers on Rightfax,. Anthem Blue Cross Customer Service Rep III Generating denial letters for concurrent, pre-cert, and pharmacy reviews. Handling multiple tasks daily while exceeding production and department goals. Training new and back-up associates in all job funtions.
Dec 2004Dec 2005

Network Management Rep

Anthem Blue Cross
Network Management Rep Non-Clicinal support within the Post Service Review. Case set up of both post service review and PDRs for both Nurses and Physician reviewers. Inputting authorizations/denials/pends into WMDS and ensuring timely letter generation. Collected and reported error report and pend report totals and provided to management.
Aug 2002Dec 2004

Provider Relations Rep

Anthem Blue Cross
Madisonville, KY Provider Relations Rep II Assisting both providers and members i0n determining/obtaining pre-authorization for upcoming medical services as well as concurrent authorization for inpatient admissions. Train new and back-up associates. Assisting RN staff in length of stay compliancy timeframes by providing hospital utilization review departments with pertinent information for patient care. Demonstrating ability to handle high levels of call volume efficiently while maintaining quality of case intake and PHI