Kathryn Gillam
Authorization Specialist
El Paso,TX
Summary
Experienced Authorization Specialist with a proven track record at Optum, UnitedHealth Group and Seton Medical Center. Strong background in managing authorizations and ensuring compliance. Skilled in navigating complex systems, problem-solving, and maintaining accurate records. Known for effective collaboration, adaptability, and delivering results in fast-paced environments. Reliable team player with expertise in healthcare regulations, communication, and customer service. Knowledgeable Authorization Specialist with proven track record in managing authorization processes and ensuring compliance with industry standards. Adept at coordinating with team members and healthcare providers, leading to streamlined operations and improved patient satisfaction. Demonstrated expertise in problem-solving and attention to detail, ensuring timely and accurate processing of authorizations.
Overview
8
8
years of professional experience
2
2
Certification
Work History
Authorization Specialist
Optum, UnitedHealth Group
12.2019 - 02.2024
- Insurance Verification - Verify patient insurance coverage and benefits related to radiology, cardiology, physical therapy and orthopedic services. Confirm that procedures are covered and determine patient responsibility (copays, deductibles, etc.).
- Prior Authorization - Initiated 60-70 prior authorizations per day. Obtain prior authorizations from insurance companies for radiology, cardiology, physical therapy and orthopedic exams. Submit clinical documentation to support the medical necessity of procedures. Follow up with payers on pending authorizations.
- Patient Communication - Inform patients about the status of their authorization. Discuss financial responsibility if authorization is denied or partially covered. Reschedule appointments if authorization is not obtained in time.
- Coordination with Clinical Staff - Work closely with radiologists, technologists, and referring providers to gather necessary documentation. Notify departments of authorization status to ensure timely scheduling.
- Documentation and Record-Keeping - Accurately document all communications and authorization details in the patient’s record or EMR system. Maintain compliance with HIPAA and all regulatory requirements.
- Denial Management - Track and manage denied authorizations. Initiate appeals or re-authorization requests when needed. Work with billing or coding departments to resolve authorization-related payment issues.
- Scheduling Support - Assist with scheduling imaging appointments once authorizations are approved.
Authorization Specialist
Seton Medical Center
06.2012 - 07.2015
- Reviewed insurance plans, benefits, and coverage criteria to determine patient eligibility for medical services.
- Prepared and submitted authorization requests; followed up with insurance carriers to ensure timely approvals.
- Communicated with referring physicians to gather documentation and clarify clinical information as needed.
- Responded to inquiries from patients and healthcare providers, explaining coverage and authorization procedures clearly.
- Maintained accurate records of authorizations and approvals to support proper billing and claims processing.
- Resolved authorization issues by collaborating with insurance companies and internal departments.
- Ensured compliance with all regulatory guidelines, organizational protocols, and payer-specific requirements.
Pharmacy Technician
Kaiser Permanente
03.1996 - 05.2004
- Answered incoming phone calls and assisted customers and healthcare providers with prescription inquiries and general pharmacy questions.
- Accurately stocked, labeled, and inventoried medications to maintain proper storage and ensure consistent availability.
- Supported pharmacists in dispensing medications by preparing, labeling, and packaging prescriptions efficiently.
- Measured and calculated dosages, filled prescriptions, and ensured label accuracy in compliance with pharmacy standards.
- Prepared non-sterile pharmaceutical compounds based on written prescriptions and safety guidelines.
- Maintained a clean, organized work environment and sterilized equipment according to safety protocols.
- Delivered medications to the front counter or drive-thru and ensured timely pickup and counseling opportunities for patients.
- Provided excellent customer service while adhering to HIPAA and pharmacy regulations.
Education
Certificate - Medical Coding
U.S. Career Institute
Fort Collins, CO11-2024
Certificate - Medical Transcription
Penn Foster Career School
Scranton, PA05-2015
Pharmacy Technician License - Pharmacy
Hi-School Pharmacy
Vancouver, WA05-1996
High School Diploma -
Fort Vancouver High School
Vancouver, WA08-1997
Skills
- Medical Insurance Verification (Commercial, Medicare, Medicaid)
- Prior Authorization & Pre-Certification Processing
- Benefits Eligibility & Coverage Review
- Familiarity with CPT, ICD-10, and HCPCS Coding
- Working Knowledge of Payer Policies and Procedures
- Experience with Insurance Portals (eg, Availity, Navinet)
- HIPAA regulations knowledge
- Electronic Medical Records (EMR) Systems (eg, Epic, Cerner, Athena)
- Accurate Data Entry & Authorization Tracking
- Medical Billing & Coding Support
- HIPAA Compliance & Confidentiality Standards
- Scheduling and Coordination with Referring Providers
- Patient Communication & Coverage Explanation
- Provider & Insurance Company Liaison
- Professional Phone Etiquette
- Conflict Resolution & Problem Solving
- Handling Patient and Provider Inquiries Efficiently
- Microsoft Office (Word, Excel, Outlook)
- Strong Organizational and Multitasking Skills
- Attention to Detail in High-Volume Environments
- Time Management & Workflow Prioritization
Accomplishments
- Maintained a 98% approval rate on prior authorization submissions through accurate documentation and payer follow-up.
- Processed an average of 50+ authorizations per week while maintaining full compliance with HIPAA and payer policies.
- Trained 3+ new team members on authorization procedures and EMR documentation standards.
Certification
- Certified Medical Coding Specialist, U.S. Career Institute - November 1st, 2024
- Certified Medical Transcriptionist, Penn Foster - May 1st, 2015
Languages
English
Full Professional
Timeline
Authorization Specialist
Optum, UnitedHealth Group
12.2019 - 02.2024
Authorization Specialist
Seton Medical Center
06.2012 - 07.2015
Pharmacy Technician
Kaiser Permanente
03.1996 - 05.2004
Certificate - Medical Coding
U.S. Career Institute
Certificate - Medical Transcription
Penn Foster Career School
Pharmacy Technician License - Pharmacy
Hi-School Pharmacy
High School Diploma -
Fort Vancouver High School
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