Summary
Overview
Work History
Education
Skills
Personal Information
Timeline
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Kaelin Domingeaux

Irving,TX

Summary

Experienced Health Insurance Specialist with a track record of efficiently managing large caseloads in fast-paced environments. Recognized for exceptional organizational skills, strong drive, and adaptability. Proficient in planning and resolving complex problems. Possessing 5 years of valuable experience, always prepared to tackle any challenge.

Overview

8
8
years of professional experience

Work History

Insurance Analyst

AbbVie/All Care Plus Pharmacy
01.2024 - Current
  • Responsible for performing the pre-test verification of insurance eligibility and pharmacy benefits to quantify insurance and patient liability portions for approximately 6-10 patients a day.
  • Successfully obtain referrals or pre-authorizations by contacting insurances and various 3rd party administrators as required to support medical necessity and clinical policy guidelines
  • Ensure patient demographic and insurance information are entered into Salesforce accurately
  • Coordinate the effective resolution of Pharmacy Benefits administration problems with the appropriate Sales/Marketing, Member Service, and Complaints, Appeals, and Grievances Representative
  • Provides subject matter expertise on Medicare, Health Insurance Exchange, and DoD regulations and guidelines applicable to pharmacy processes.
  • Viewed reports regularly to make sure processing was conducted efficiently.

Insurance Verification Specialist

SCA Health
08.2021 - 09.2023
  • Responsible for performing the pre-test verification of insurance eligibility and benefits for all scheduled patients to quantify insurance and patient liability portions
  • Resolve claim denials as needed
  • Successfully obtain referrals or pre-authorizations by contacting insurances and various 3rd party administrators as required to support medical necessity and clinical policy guidelines
  • Processed upfront patient payments prior to the date of service
  • Analyze workers' compensation claims by investigating to confirm coverage and compensability per state.
  • Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.

Admissions Coordinator and Patient Advocate

Baylor Scott & White Orthopedic Hospital
12.2016 - 06.2021
  • Scheduled new and established patient appointments, surgeries, and therapeutic services
  • Performed approximately 20-50 patient registrations, insurance validation and consents upon intake per day.
  • Estimated charges for scheduled services and collected necessary deposits and upfront patient portions to support third party and self-pay billing
  • Facilitated approximately 50-100 inbound calls to respectful departments within the hospital, physician group office and the central business office additionally
  • Successfully cultivated patient relationships through proactive communications regarding surgical status (pre & post operatively).
  • Confirmed all insurance benefits met standards of admissions as dictated by policy.
  • Provided exceptional customer service during phone and email interactions with patients and their families, addressing concerns promptly and professionally.
  • Planned, designed, and implemented changes for a large project; to ensure updates and all communications possible could be received by patient families.

Education

Bachelor’s Degree - Science – Pre Nursing

University of Texas At Arlington
Arlington, Tx
12.2019

Skills

  • Customer Service
  • Detail Oriented
  • Payer Policies & Guidelines
  • Administrative Duties
  • Pre-Authorization & Denials Management
  • Microsoft Office
  • Claims Adjusting
  • Time Management
  • Data Analysis
  • Project Coordination
  • Policy analysis
  • Claims Management

Personal Information

Title: Revenue Cycle and Claims Specialist

Timeline

Insurance Analyst

AbbVie/All Care Plus Pharmacy
01.2024 - Current

Insurance Verification Specialist

SCA Health
08.2021 - 09.2023

Admissions Coordinator and Patient Advocate

Baylor Scott & White Orthopedic Hospital
12.2016 - 06.2021

Bachelor’s Degree - Science – Pre Nursing

University of Texas At Arlington

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Kaelin Domingeaux