Jordan Fowler
Perkasie
Summary
Results-driven professional with extensive experience in utilization review management and medical necessity assessment. Known for strong problem-solving skills and leadership, successfully improving workflow efficiency and compliance across healthcare settings.
Overview
10
10
years of professional experience
Work History
Utilization Review Manager
Innovative Billing Solutions
Los Angeles
06.2023 - Current
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Led and supervised a team of utilization review specialists, ensuring accuracy, compliance, and efficiency in case reviews and documentation.
- Performed prior authorization review of services requiring notification.
- Performed AR analysis and aged billing review to identify revenue opportunities and recover outstanding claims.
- Managed utilization review processes, evaluating medical necessity and aligning treatment with payer guidelines to secure approvals.
- Conducted verification of benefits (VOBS) to confirm coverage and eliminate delays in admissions and treatment authorizations.
- Devise or identify solutions for irregular requests and issues.
Clinical Utilization Reviewer
Phoenix House
Long Island City
08.2020 - Current
- Collect, analyzes, and provide pertinent, timely clinical information including medications, to payer sources and external utilization review personnel for authorization of inpatient stay and services of the initial, concurrent, and discharge authorizations and review which are completed through interactions with the client's insurance companies during normal business hours including, nights, weekend and holidays as necessary.
- Review and monitor each step of the authorization process to proactively identify and resolve problems.
- Interact with physicians and therapists on an on-going basis to assure patient assessment and treatment planning are appropriately coordinated to gather all clinical information to determine the medical necessity of requested healthcare per the ASAM criteria.
- Assure services are accurately and consistently reflected in facility documentation.
- Maintain a daily record in the Electronic Health Record (EHR) system of the concurrent review process and inform the treatment team of the authorization status of each assigned patient.
- Ensure program compliance with all CARF, DEA, DOH, BHDDH, local, state, and federal regulations and licensing requirements.
- Proficiency with CPT coding.
Utilization Review Specialist
Zinnia Health
Newport Beach
04.2021 - 07.2024
- Conducted clinical reviews and prepared detailed case summaries to support medical necessity and payer compliance.
- Monitored length of stay and level of care transitions to minimize denials and maximize reimbursement.
- Established and maintained positive working relationships with payer representatives, resulting in faster approvals and reduced denials.
- Trained staff on documentation standards and payer requirements, improving accuracy and compliance.
- Assisted with CARF and JCAHO accreditation preparation by ensuring UR policies and documentation met regulatory standards.
- Identified process inefficiencies and implemented workflow improvements that enhanced both clinical and financial outcomes.
Utilization Review Specialist
Nexus Billing Solutions
Boca Raton
06.2018 - 07.2020
- Advocate for patients to receive medical care, communicate with insurance carriers providing clinical information to justify medical necessity, navigating multiple EHR's and insurance platforms to perform duties in an effective and timely manner, evaluating and preparing medical records to be discussed with clinicians and care managers utilize time management skills to schedule and perform new admission reviews, concurrent reviews, faxes and documentation of completed tasks, maintains comprehensive knowledge of levels of care and seeks to collect new and updated information on medical policies and guidelines, all while being vigilant of HIPAA compliance standards and familiar with ASAM and medical necessity criteria.
- Basic understanding of the Utilization review process
- Comprehensive knowledge of all levels of care (Detox, RTC, PHP, IOP, OP)
- Familiar with ASAM / and or medical necessity criteria for each level of careKnowledge in day to day operations of a psychiatric or behavioral health setting
- Effective communication skills, both verbal and written via phone and email
- Proficiency with Microsoft Office products including Word, Excel, and Power Point
- Knowledge in computers and can navigate various software programs
Housing Supervisor
Atlantic Recovery Center
Davie
06.2015 - 03.2018
- Assisted doctors and nurses with the treatment of patients who have various behavioral diagnosis such as substance abuse, post-traumatic stress disorder, mental illness and physical emotional abuse.
- Responsible for and managed over 10+ behavioral health technicians with scheduling, hiring and planning the day-to-day operations for staff and clients, received multiple promotions.
Education
High school diploma -
Berker High School
Richardson, TX05-2011
Skills
Benefit coverage evaluation
- Utilization review management
- Medical necessity assessment
- CPT coding
- Authorization coordination
- Compliance monitoring
- Clinical documentation standards
- Team leadership
- Effective communication
- Problem solving
- Training and development
- Relationship building
- Workflow improvement
- Healthcare regulations
- HIPAA compliance
- Case review expertise
- Medicaid management
- EMR software proficiency
Websites
Timeline
Utilization Review Manager
Innovative Billing Solutions
06.2023 - Current
Utilization Review Specialist
Zinnia Health
04.2021 - 07.2024
Clinical Utilization Reviewer
Phoenix House
08.2020 - Current
Utilization Review Specialist
Nexus Billing Solutions
06.2018 - 07.2020
Housing Supervisor
Atlantic Recovery Center
06.2015 - 03.2018
High school diploma -
Berker High School
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