Heather Kane
Morrisville,PA
Summary
Dynamic healthcare professional with over 12 years of experience at Trinity Health, excelling in patient access and financial clearance. Proven track record in optimizing insurance verifications and authorizations, enhancing operational efficiency. Skilled in EHR systems and fostering teamwork, consistently achieving high success rates in securing patient care approvals.
Overview
16
16
years of professional experience
Work History
Specialist II, Financial Clearance, Pt. Access
Trinity Health
09.2024 - Current
- Verified insurance eligibility and benefits for patients, ensuring accurate coverage information.
- Coordinated with healthcare providers to obtain necessary authorizations for services rendered.
- Utilized electronic health record systems to update patient information and track verification statuses.
- Communicated effectively with patients regarding their insurance options and coverage details.
- Resolved discrepancies in insurance claims by collaborating with billing departments and insurers.
- Maintained detailed records of verification processes to support compliance and audit requirements.
- Assisted team members in training on new software tools for streamlined verification processes.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Posted payments to accounts and maintained records.
Central Scheduling Specialist
Trinity Health
03.2024 - 09.2024
- Coordinated patient appointments across multiple departments to optimize scheduling efficiency.
- Managed phone inquiries and directed callers to appropriate resources in a timely manner.
- Processed and maintained accurate patient records using electronic health record systems.
- Assisted in resolving scheduling conflicts, ensuring seamless patient care delivery.
- Monitored appointment flow and adjusted schedules proactively to minimize wait times for patients.
- Used electronic systems to enter provider orders and retrieve test results.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Obtained payments from patients and scanned identification and insurance cards.
Prior Authorization Specialist
Comprehensive Urology - Trinity Health
07.2016 - 03.2024
- Processed prior authorization requests efficiently to ensure timely patient care for 10 providers.
- Reviewed medical documentation for compliance with insurance guidelines and protocols.
- Communicated effectively with healthcare providers to clarify information and resolve issues.
- Utilized electronic health record systems to track authorizations and streamline workflows.
- Assisted in training new staff on procedures related to prior authorization processes.
- Implemented process improvements that reduced turnaround time for authorization requests.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
Bank Teller
Wells Fargo
12.2009 - 05.2011
- Processed customer transactions efficiently while ensuring compliance with bank policies and procedures.
- Assisted customers with account inquiries, providing accurate information and resolving issues promptly.
- Maintained cash drawer accuracy through diligent monitoring and reconciliation practices.
- Managed high-volume transactions during peak hours while maintaining attention to detail, ensuring seamless customer experience.
- Counted and packaged currency and coins.
- Educated customers on use of banking website and mobile apps.
- Identified fraudulent activities by diligently monitoring transactions and reporting suspicious activity to management.
Education
No Degree - Psychology
Bucks County Community College
Newtown, PASkills
- Customer relations
- Proficient in Athena, NextGen, Epic EHR systems
- Teamwork and collaboration
- Proficient with multiple provider portals ie Pear Portal, Availity, Navinet, Quantum Health, UMR, etc
- Adaptability
- 12 years of administrative health care experience
Timeline
Specialist II, Financial Clearance, Pt. Access
Trinity Health
09.2024 - Current
Central Scheduling Specialist
Trinity Health
03.2024 - 09.2024
Prior Authorization Specialist
Comprehensive Urology - Trinity Health
07.2016 - 03.2024
Bank Teller
Wells Fargo
12.2009 - 05.2011
No Degree - Psychology
Bucks County Community College
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