LATIA DOVAL
Winston-Salem
Summary
Dependable and knowledgeable Medical Management professional with 10+ years of healthcare and health insurance experience, including utilization management, case creation, prior authorization, claims processing, discharge coordination, and provider outreach. Experienced in telephonic and non-telephonic environments with strengths in healthcare terminology, clinical and non-clinical information gathering, complex case support, process improvement, and internal resource development. Seeking to leverage this experience in a Medical Management Specialist or healthcare operations role.
Overview
11
11
years of professional experience
Work History
Special Project – Authorization & Discharge Support
Elevance Health
01.2025 - 05.2026
- Researched and verified member discharge dates, ensuring accurate and timely authorization case closure.
- Confirmed discharge information and collected required non-clinical data from providers via telephone and email.
- Tracked and updated discharge and authorization information in internal systems, maintaining data accuracy and compliance.
Utilization Management Representative II – Non-Telephonic
Elevance Health
11.2021 - 05.2026
- Processed pre-certification and prior authorization cases for inpatient and outpatient services, ensuring timely and accurate reviews.
- Sorted incoming requests and routed them to the appropriate workflow or queue for case creation, additional information, or follow-up.
- Gathered clinical and non-clinical information and appropriately routed cases to utilization management, case management, quality improvement, or medical review workflows.
- Creates cases and added supporting information for outpatient, inpatient rehabilitation, and home health services.
- Guided Utilization Management Representatives on pre-certification inquiries and complex workflow issues, enhancing team support and resolution efficiency.
- Developed and updated internal documents, reference materials, and resources, and trained associates on new systems and procedures.
- Facilitated training for new hires and support associates during system and process changes.
- Researched workflow questions and identified process improvements, presenting findings to leadership and team members to drive operational enhancements.
Utilization Management Representative III – Telephonic
07.2019 - 11.2021
- Created cases for pre-certification and prior authorization review while assisting providers with utilization management inquiries by telephone.
- Guided UM Representatives in handling correspondence, authorization processes, and complex inquiries to enhance support quality.
- Identified improvement areas and participated in project initiatives to streamline departmental operations.
- Managed escalated provider and team-member calls, researched issues, and directed concerns to appropriate resources for effective resolution.
- Identified areas for improvement and participated in project initiatives and additional departmental responsibilities.
Utilization Management Representative II
12.2017 - 07.2019
- Processed authorization requests for Medicare emergency room admissions, observation services, and durable medical equipment to ensure timely patient access to necessary care.
- Verified member benefits and eligibility information to enhance accuracy of authorization processing.
- Assisted new hires during training and supported associates with complex cases as a Subject Matter Expert (SME).
- Coordinated project activities and organized company-wide events as a Sunshine Committee Representative to foster employee engagement.
Customer Care Representative III
12.2015 - 12.2017
- Delivered customer service and support to providers on claim statuses, issues, and benefit inquiries, ensuring timely resolutions.
- Guided members on medical, dental, and vision benefits while resolving billing concerns to enhance member satisfaction.
- Reprocessed claims and supported members and providers with the online platform for streamlined claim management.
- Reprocessed claims and assisted members and providers with the online platform.
Customer Care Representative II
02.2015 - 12.2015
- Addressed inquiries on pharmacy issues, medical admissions, and provider eligibility to ensure accurate information delivery.
- Processed incoming faxes and managed authorization requests for medical admissions and observations, facilitating timely patient care.
- Identified operational challenges and customer service issues, providing actionable feedback to enhance service quality.
Customer Care Representative I
12.2014 - 02.2015
- Resolved member inquiries on insurance benefits, provider contracts, and eligibility, enhancing member understanding.
- Tracked, troubleshot, and resolved customer service issues using internal computerized systems, improving response times.
- Gathered information and resolved issues, contributing to improved overall service quality.
Education
Associate Degree - Healthcare Management
Southern New Hampshire University
06.2018
Skills
- Medical Authorization Processing & Case Creation
- Discharge Research & Provider Communication
- Claims Processing & Benefits/Eligibility
- Clinical & Non-Clinical Information Gathering
- Workflow management
- Process Improvement & Resource Development
- Microsoft Office Suite (Excel, Outlook, Word, PowerPoint)
- Problem-solving
- Collaboration skills
- Authorization Compliance
Timeline
Special Project – Authorization & Discharge Support
Elevance Health
01.2025 - 05.2026
Utilization Management Representative II – Non-Telephonic
Elevance Health
11.2021 - 05.2026
Utilization Management Representative III – Telephonic
07.2019 - 11.2021
Utilization Management Representative II
12.2017 - 07.2019
Customer Care Representative III
12.2015 - 12.2017
Customer Care Representative II
02.2015 - 12.2015
Customer Care Representative I
12.2014 - 02.2015
Associate Degree - Healthcare Management
Southern New Hampshire University