Kaiulani Wright
Orlando,FL
Summary
Administration Business Professional with over 7 years' experience in office management, administrative, acquisition, and contract management support as well as a unique ability of completing special projects with a high degree of efficiency. Fosters cross functional communication to formulate effective business solutions. Adept at prioritizing and completing multiple tasks simultaneously to achieve and exceed project goals. Exceptional interpersonal and written communication skills.
Overview
18
18
years of professional experience
Work History
Prior Authorization Representative
Simon Med
01.2021 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Tracked referral submission during facilitation of prior authorization issuance.
- Worked closely and listened to team members' feedback to identify issues and resolve conflicts.
- Worked to provide continuous improvement for product development lifecycle.
Admin/Insurance Verification Specialist
The Women's Center
11.2019 - 01.2021
- Review patient deductibles and/or copays and flag information into billing system, so information is provided to front-end department (Administrator) at all location
- Trained new staff on current, correct insurance verification procedures.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Assisted patients with understanding personalized insurance coverage and benefits.
Patient Service Specialist
UCF College of Medicine
01.2019 - 11.2019
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Managed patient registration process, confirming data accuracy and completeness.
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Built and maintained positive working relationships with patients and staff.
Billing and Reimbursement Specialist
Express Scripts
04.2017 - 08.2018
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Trained department employees in proper billing and accounting procedures.
Policy Support Assistant
CNA Insurance
04.2015 - 01.2017
- Mentored new hires, resulting in stronger staff development and increased productivity.
- Monitored and reported trainee progress, introducing new learning tools to address individual needs.
- Developed effective training plans based on department needs and objectives.
- Developed individualized training plans to achieve staff readiness.
- Investigated allegations to check validity and recommend actions to minimize risk.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
Card Service Advisor
JP Morgan Chase
01.2013 - 04.2015
- Maintained high customer satisfaction standards to meet or exceed targets.
- Handled customer issues with confidence, using complex problem solving to provide effective resolution.
- Developed lasting relationships with customers, which helped to bring in additional business opportunities.
Commercial Specialty Processor
Nationwide Insurance
02.2006 - 01.2013
- Reviewing and processing commercial specialty transactions, such as insurance claims, applications, or legal documents
- Ensuring accuracy and completeness of submitted documents by verifying information, signatures, and supporting documentation
- Following established procedures and guidelines to process transactions efficiently and within specified timeframes
- Collaborating with internal teams, such as underwriters, claims adjusters, or legal professionals, to gather additional information or resolve any discrepancies
- Conducting research and analysis to validate authenticity and legitimacy of commercial documents or transactions
- Maintaining detailed records and documentation of processed transactions, including any relevant notes or updates
- Communicating with clients, customers, or external stakeholders to provide updates, request additional information, or address any concerns or inquiries
- Adhering to regulatory requirements and company policies to ensure compliance and mitigate any potential risks
- Participating in training programs or workshops to enhance knowledge of commercial specialty processes, industry trends, and relevant software or tools
- Assisting in development and improvement of processing procedures to enhance efficiency and accuracy.
Education
Certified Scrum Master - Scrum Master
Scrum Alliance
Orlando, FL11.2023
Google IT Support Certification -
Google
Orlando, FL09.2022
Skills
- Record Management
- Quality Assurance
- Agile Methodologies
- Sprint Planning
- Medical Billing
- Project Management
- Microsoft 365 (Excel, Outlook, Word, PowerPoint, Publisher)
- Communication
- Customer Collaboration
- Agile Process Refinement
- Office Administration
- Leadership/Interpersonal Skill
- Solution Focused
Citizenship
US Citizen
Security Clearance
None
Timeline
Prior Authorization Representative
Simon Med
01.2021 - Current
Admin/Insurance Verification Specialist
The Women's Center
11.2019 - 01.2021
Patient Service Specialist
UCF College of Medicine
01.2019 - 11.2019
Billing and Reimbursement Specialist
Express Scripts
04.2017 - 08.2018
Policy Support Assistant
CNA Insurance
04.2015 - 01.2017
Card Service Advisor
JP Morgan Chase
01.2013 - 04.2015
Commercial Specialty Processor
Nationwide Insurance
02.2006 - 01.2013
Certified Scrum Master - Scrum Master
Scrum Alliance
Google IT Support Certification -
Google
Similar Profiles
Desirae MaciasDesirae Macias
Physician Assistant at Simon MedPhysician Assistant at Simon Med
Brenda ZendejasBrenda Zendejas
Physician Relations at Simon MedPhysician Relations at Simon Med
Delmir PenunuriDelmir Penunuri
Attorney Relations Specialist at Simon MedAttorney Relations Specialist at Simon Med