Erika Anthony
Ontario
Summary
Dynamic Utilization Review Coordinator at Acadia Healthcare with expertise in HIPAA compliance and interdisciplinary collaboration. Proven track record in enhancing service delivery through comprehensive utilization reviews and effective communication with stakeholders. Skilled in medical necessity assessment, driving quality improvement initiatives that optimize patient care pathways and ensure regulatory compliance.
Experienced healthcare professional with strong background in utilization review and care coordination. Proven ability to assess medical necessity, optimize resource use, and ensure compliance with healthcare regulations. Focused on team collaboration and achieving results, adapting to changing needs efficiently. Highly skilled in clinical guideline adherence, patient advocacy, and effective communication.
Overview
8
8
years of professional experience
Work History
Utilization Review Coordinator
Acadia Healthcare
04.2025 - 08.2025
- Conducted comprehensive utilization reviews to ensure compliance with clinical guidelines and regulations.
- Collaborated with multidisciplinary teams to develop individualized treatment plans for patients.
- Analyzed patient data and outcomes to improve service delivery and care effectiveness.
- Facilitated communication between healthcare providers, insurers, and patients regarding authorization processes.
- Evaluated medical necessity criteria using evidence-based guidelines to ensure that services provided were both clinically appropriate and costeffective.
Referral Coordinator
Prime Healthcare Management
06.2023 - 03.2025
- Coordinated patient referrals to optimize care pathways and enhance patient experience.
- Streamlined communication between healthcare providers and patients, ensuring timely appointment scheduling.
- Managed referral tracking system for increased accuracy in data management and reporting.
- Collaborated with multidisciplinary teams to resolve patient inquiries and improve service delivery.
- Maintained comprehensive records of referrals, ensuring compliance with regulatory requirements and internal policies.
- Processed referral requests from patients, doctors and other health care professionals.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
Medical Biller
Drake Institute of Research
01.2018 - 10.2021
- Processed and submitted medical claims to ensure timely reimbursements.
- Reviewed patient records for accuracy and compliance with billing regulations.
- Implemented improvements in billing workflows, enhancing efficiency and reducing errors.
- Trained new staff on billing procedures and software systems for optimal performance.
- Monitored accounts receivable aging reports to identify outstanding payments and follow up accordingly.
- Conducted audits of billing processes, ensuring adherence to industry standards and best practices.
Education
Associate of Science - Healthcare Administration
San Joaquin Valley College
Hesperia, CA06-2011
Skills
- HIPAA compliance
- Quality improvement
- Healthcare regulations
- Interdisciplinary collaboration
- Utilization management
- Medical necessity assessment
- Case review expertise
Timeline
Utilization Review Coordinator
Acadia Healthcare
04.2025 - 08.2025
Referral Coordinator
Prime Healthcare Management
06.2023 - 03.2025
Medical Biller
Drake Institute of Research
01.2018 - 10.2021
Associate of Science - Healthcare Administration
San Joaquin Valley College