Pamela Matthews
Capitol Heights
Summary
Skilled Utilization Management Coordinator with strong expertise in authorization management, healthcare compliance, and patient advocacy.
Overview
14
14
years of professional experience
Work History
Utilization Management Coordinator II
CareFirst BCBS
Washington
02.2022 - 09.2025
- Coordinated authorization requests for medical services and procedures.
- Communicated with patients with compassion while keeping medical information private.
- Review the authorization request for initial determination and/or triage for clinical review.
- Ability to multitask, prioritize, and maintain organization systems.
- Excellent analytical and problem-solving skills.
- Effective written and interpersonal communication skills to engage with healthcare providers and/or facilities.
- Coordination of services for patients, Continuity of Care.
- Peer-to-peer review inquiries for medical director determinations.
- Microsoft Office, Excel, Icentrix,
Utilization Management Coordinator I
CareFirst BCBS
Washington
09.2011 - 11.2023
- Call Center for Medical Management authorization request for inpatient, outpatient services, including mental health, physical therapy.
- Knowledge of CPT codes and ICD-10 codes.
- Microsoft Office. ICentrix, Excel.
- Coordination of services for continuity of care.
- Peer-to-peer review for authorization denials.
Education
High School Diploma -
Medex
Silver Spring, MD02-1982
High School Diploma -
Northwestern High School
Hyattsville, MD06-1981
Skills
- Authorization management
- ICD-10 coding
- CPT coding
- Clinical review
- Utilization coordination
- Healthcare compliance
- Analytical thinking
- Organization skills
- Interpersonal engagement
- Critical thinking
- Documentation accuracy
- Patient support
- Continuity of care
- Service coordination
- Teamwork and collaboration
- Multitasking Abilities
- Teamwork
References
References available upon request.
Timeline
Utilization Management Coordinator II
CareFirst BCBS
02.2022 - 09.2025
Utilization Management Coordinator I
CareFirst BCBS
09.2011 - 11.2023
High School Diploma -
Medex
High School Diploma -
Northwestern High School