Lauren Higgins
Peyton
Summary
Dedicated healthcare and administrative professional with expertise in Medicare counseling, patient advocacy, and program coordination within behavioral health settings. Demonstrates strong case management, training, and communication skills, with a background in serving aging and disabled adults. Seeking a remote Utilization Review Specialist position to contribute to compliance, patient care optimization, and effective healthcare coordination.
Overview
7
7
years of professional experience
Work History
Case Aide
The Resource Exchange
02.2024 - Current
- Support adults and children with intellectual, behavioral and developmental disabilities, as well as their families, in care planning and service delivery.
- Draft and revise individualized service plans (ISPs), including annual service plans, plan revisions, and terminations, ensuring accuracy and compliance with state and Medicaid regulations.
- Communicate with families and providers to review services, notify of updates, and ensure understanding of changes and authorizations.
- Review prior authorization (PAR) submissions, track approvals and denials, and update member records accordingly.
- Maintain accurate client data and change-of-information updates in confidential member files using platforms such as Excel, CCM, Medisked, Docusign and Nitro Pro.
- Train new staff and peers on plan documentation procedures and system navigation.
Program Technician / HICAP Counselor
Kern County Aging and Adult Services
10.2020 - 09.2022
- Delivered unbiased Medicare and Medi-Cal counseling to seniors and disabled adults, improving benefits access and care continuity.
- Conducted community outreach and training presentations on healthcare benefits, coverage rules, and appeals procedures.
- Prepared and submitted APS reports involving elder abuse, self-neglect, and dependent adult abuse.
- Guided clients through insurance enrollment processes and Medi-Cal renewals.
- Demonstrated extensive experience in managing state and private insurance appeals and authorizations.
- Partnered with senior centers and community agencies to identify and support at-risk populations.
- Maintained strict documentation and compliance with HIPAA standards and regulatory procedures.
Pre-Imaging Service Representative
Austin Radiological Association
04.2019 - 12.2019
- Scheduled diagnostic imaging services and ensured accurate insurance and diagnosis code alignment (ICD-10).
- Created and managed patient/provider accounts and ensured secure handling of PHI.
- Collaborated with referring physicians to coordinate pre-authorizations and resolve procedural discrepancies.
- Provided remote administrative support while maintaining productivity and service standards.
Retention Specialist
Scott & White Health Plan
08.2018 - 01.2019
- Conducted member outreach to communicate insurance updates, plan resources, and enrollment options.
- Supported members in accessing care and using the patient portal, improving service utilization.
- Processed eligibility verification and facilitated plan changes during enrollment periods.
- Maintained accurate service documentation and followed compliance standards.
Education
Master of Business Administration - MBA
University of Phoenix
05.2018
Bachelor of Science - Health Administration, Health Management
University of Phoenix
02.2016
Associate of Science - Medical Assisting
San Joaquin Valley College
02.2012
Skills
- Medicare & Medicaid Counseling
- Advanced Case Management & Patient Advocacy
- Insurance Enrollment & Documentation Compliance
- HIPAA Compliance & APS Reporting
- Community Outreach & Training
- Microsoft Office, Google Workspace, TEAMS, Docusign, CCM, Medisked, Nitro Pro
- ICD-10 Coding Knowledge
- Excellent Written and Verbal Communication
Timeline
Case Aide
The Resource Exchange
02.2024 - Current
Program Technician / HICAP Counselor
Kern County Aging and Adult Services
10.2020 - 09.2022
Pre-Imaging Service Representative
Austin Radiological Association
04.2019 - 12.2019
Retention Specialist
Scott & White Health Plan
08.2018 - 01.2019
Bachelor of Science - Health Administration, Health Management
University of Phoenix
Associate of Science - Medical Assisting
San Joaquin Valley College
Master of Business Administration - MBA
University of Phoenix
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