KRISTEN SEYMOUR
Pearland,TX
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
28
28
years of professional experience
Work History
Insurance Follow-Up Rep II
Kelsey Seybold Clinic
Pearland, Texas
06.2023 - 04.2024
- Posts payments and reconciles account balances
- Processes patient and insurance refunds
- Reviews open accounts for account reconciliation and next steps to resolve open balances
- Contacts patients and insurance carriers as needed to resolve open balances and account issues
- Communicates with ancillary departments and agencies regarding account errors, billing edits, denials and charge issues
- Reviews payments for accuracy and appropriate account distribution
- References contracts for payment and balance accuracy
- Posts adjustments as needed and directed to resolve open balances
- Reviews and works denials as needed, updates and drafts appeals as needed to carriers to resolve open account balances
- Reviews open AR to identify and resolve accounts receivable as well as escalate issues as needed
- Composes and types routine correspondence, memos, letters, etc
- Responsible for updating the patient accounts
- System with information and notes as needed.
- Reviewed and validated insurance claims for accuracy, completeness, and compliance with established policies and procedures.
- Called insurance companies to follow-up on unpaid or rejected claims.
- Maintained accurate records of claim status information in the database system.
- Identified and resolved discrepancies between submitted claims and insurance carriers' responses.
- Researched patient accounts to ensure proper billing codes were used.
- Processed appeals when necessary by gathering additional supporting documentation from providers.
- Collaborated with other departments within the organization to ensure all deadlines are met for timely submission of claims.
- Analyzed data trends related to insurance rejections in order to identify areas of improvement in our operations process.
- Developed strategies to improve communication between departments within the organization related to claim processing activities.
- Ensured that all documents were filed accurately according to established protocols.
- Generated reports on a weekly basis detailing key performance indicators such as turnaround times, denials rates.
- Provided advice and guidance on best practices for resolving disputes between providers and payers.
- Worked closely with team members across multiple departments in order to resolve complex issues quickly.
- Participated in regular meetings with management teams in order to discuss current challenges and strategies for improvement.
- Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
- Referred unresolved customer grievances to designated departments for further investigation.
- Prepared and evaluated CRM reports to identify problems and areas for improvement.
Prior Authorization Specialist
Kelsey Seybold Clinic
Pearland, Texas
09.2022 - 06.2023
- Documented all prior authorization information in patient profiles, including approval dates and prior authorization numbers
- Processed referrals and submitted clinical supporting documentation to insurance carriers to expedite prior authorization processes
- Secured patients' demographics and medical information using discretion to protect privacy
- Managed correspondence with insurance companies, physicians and patients as required
- Reviewed denials and submitted appeals to gain approval from insurance companies
- Prioritized prior authorizations in alignment with expiration deadlines
- Assisted with medical necessity documentation to expedite approvals and confirm appropriate follow-up
- Reviewed accuracy and completeness of information requested and verified presence of all supporting documentation.
Interim Office Manager/Referral Coordinator Specialist
SimcarePLLC
Sugar Land, Texas
10.2020 - 09.2022
- Coordinated with physicians office personnel and patients to obtain accurate registration information
- Provided and followed clear verbal and written instructions
- Reviewed and managed Epic work queues to maintain accurate and timely authorization requests
- Promoted atmosphere of team member empowerment and collaboration
- Researched, compiled and created reports from databases and spreadsheets
- Communicated with providers regarding pending referrals and issues pertaining to processing requested referrals
- Listened carefully to the patient's questions and concerns
- Maintained documentation and logs of patient referrals
- Acquired insurance authorizations for procedures and tests ordered by an attending physician
- Coordinated referral to external medical providers
- Utilized clinical skills to clinically manage and coordinate patient cases
- Verified and entered patients demographic data into a computer database
- Established and maintained an environment that encouraged teamwork, interdependence and ethical behavior
- Served as liaison between insurance company, patient and physician
- Verified insurance coverage and obtained authorizations from insurance plans
- Provided ongoing leadership development and training.
C-Level Executive Assistant
TLC Engineering
Houston, Texas
05.2006 - 03.2020
- Manage sensitive matters with a high level of confidentiality and discretion especially decisions directly impacting the global operations of the company
- Sustain a daily calendar of meetings and events
- Prepare Word, Excel, PowerPoint presentations, agendas, reports, special projects and other documents in support of objectives for the organization
- Arrange travel and accommodations for executives
- Prepare expense reports
- Screen incoming telephone calls; take and deliver accurate messages; respond to requests by gathering and providing information and referring non-routine calls to the appropriate staff
- Excellent communication and time management skills; proven ability to meet deadlines
- Ability to function well in a high-paced environment; performs additional duties as assigned by executives
- Draft and prepare correspondence for internal announcements, board meetings, and organizations that the executive is involved with
- Manage the Executive's contacts
- Assist in preparing and managing presentations and decks
- Be responsive to emails/texts/phone calls, with contact outside normal business hours
- Welcome the Executive's guests by greeting them, in person or on the phone; answering or directing inquiries
- Use discretion, confidentiality, and good judgment to handle C-Level matters
- Represent the company and the Executive in a positive light through great follow-through skills and sound judgment
- Conserve the Executive's time by reading, researching, collecting and analyzing information as needed, in advance
- Complete projects as assigned - such as personal events and/or family needs
- Organize complex calendars and schedules; resolving any scheduling issues.
Front Desk Medical Administrative
Therapeutic Concepts
Houston, Texas
07.1996 - 04.2006
- Update and maintain patient's health records
- Assist patients with initial paperwork
- Schedule and coordinate appointments
- Process insurance claims in compliance with law requirements
- Use medical software to support all transactions
- Manage receivable and payable accounts and maintain financial records
- Answer patientsʼ queries and ensure quality customer service
- Collaborate with doctors and nurses to help with medical examinations, schedule tests and order supplies
- Ensure compliance with procedures
- Keep up-to-date with changes in medical and insurance legislation.
Education
MBA in Business Administration -
Texas Southern University
12.2015
Bachelor of Science in Health Administration, Public Affairs -
Texas Southern University
05.2011
Skills
- Medical terminology
- Event Planning
- Care Management
- Web Portals
- Insurance Verification
- Conflict Resolution
- Organizational Skills
- Insurance procedures
- EHR
- EPIC
- eClinicals
- Authorization /Referrals
- Analytical thinking
- Task prioritization
- Teamwork
- HIPAA Compliance
- Insurance Verification
- Quality Assurance Control
- Report Generation
- Data Management
- Cross-Functional Teamwork
References
References available upon request
Timeline
Insurance Follow-Up Rep II
Kelsey Seybold Clinic
06.2023 - 04.2024
Prior Authorization Specialist
Kelsey Seybold Clinic
09.2022 - 06.2023
Interim Office Manager/Referral Coordinator Specialist
SimcarePLLC
10.2020 - 09.2022
C-Level Executive Assistant
TLC Engineering
05.2006 - 03.2020
Front Desk Medical Administrative
Therapeutic Concepts
07.1996 - 04.2006
MBA in Business Administration -
Texas Southern University
Bachelor of Science in Health Administration, Public Affairs -
Texas Southern University
Similar Profiles
Sabine BouquetSabine Bouquet
Medical Assistant Intern at Kelsey Seybold ClinicMedical Assistant Intern at Kelsey Seybold Clinic
AMBER BROWNEAMBER BROWNE
RN Supervisor – Primary Care and Specialty at Kelsey-Seybold Clinic (River Oaks)RN Supervisor – Primary Care and Specialty at Kelsey-Seybold Clinic (River Oaks)
Katherine OwenKatherine Owen
Senior Director, Nursing Services at Kelsey-Seybold ClinicSenior Director, Nursing Services at Kelsey-Seybold Clinic
Josue GarciaJosue Garcia
ASR at Kelsey Seybold ClinicASR at Kelsey Seybold Clinic
Michael MeridethMichael Merideth
Lead Technician at ITS Lodging SolutionsLead Technician at ITS Lodging Solutions