Kayla Rourke
Jeffersonville,IN
Summary
Dedicated and detail-oriented worker proudly offering over 10 years' experience managing medical documents meticulously. Polished professional known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Multitasks expertly in fast-paced environments. Successfully works as part of team to reach personal and business goals. Known for successfully handling escalated customer support issues.
Overview
17
17
years of professional experience
Work History
Prior Authorization Specialist
Norton Health Care
Louisville, KY
01.2024 - Current
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Provided guidance to providers regarding the prior authorization process.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Processed appeals in a timely manner as per policy guidelines.
- Maintained accurate records of all authorization activities in the database system.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Assisted with developing policies and procedures related to prior authorizations.
- Ensured compliance with state and federal regulations pertaining to prior authorizations.
- Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
Administrative Assistant
Quantum Shopping Solutions
Louisville, KY
09.2022 - 01.2024
- · Provided secretarial and office management support while building cooperative working relationships.
- · Scheduled appointments, meetings, and events for management staff.
- · Coordinated appointments, meetings, and conferences.
- · Managed physical and digital files, monitored spreadsheets and updated reports to coordinate project materials.
- · Prepared and prioritized calendars and correspondence.
- · Developed administrative processes to achieve organizational objectives and improve office efficiency.
- · Utilized editing programs to proofread content for typo-free emails, memos, and documentation.
- Scheduled staff and monitored resource allocation to provide optimal coverage and service.
Patient Care Coordinator
OptumRx
Jeffersonville , IN
07.2018 - 09.2022
- Processed patient intake information and updated medical records prior to treatment.
- · Communicated with patients to ensure quality of care and develop care plans.
- · Completed insurance verifications and claim forms for patient intake and processing.
- · Liaised effectively with patients, doctors, and staff members, assessing medical charts, and promoting high level of communication and interaction.
- · Troubleshot and resolved complex customer service issues to enhance patient and family experience.
- Compiled and maintained medical charts and reports in complex digital databases.
Customer Ser
Humana
Louisville, KY
09.2015 - 12.2017
- · Delivered fast, friendly, and knowledgeable service for routine questions and service complaints.
- · Interacted with customers to provide and process information in response to inquiries, concerns and requests about services and products.
- · De-escalated customer issues with proven conflict mediation and problem-solving abilities.
- · Kept customer and system account information accurate and current to support timely resolutions for concerns.
- · Promptly responded to customer inquiries and resolved complaints to promote loyalty.
- · Maintained high satisfaction score by consistently resolving first-call issues.
- · Delivered customer support to high call load each shift.
- · Researched resolutions, contacted necessary departments and responded to customers by phone, mail or fax as follow-up.
- · Educated customers where applicable to alleviate the need for future contact.
- · Followed up on emailed or web-submitted customer inquiries within standard response times.
- Documented customer correspondence in CRM to track requests, problems, and solutions.
Office Manager
Dr. R. Clay Gilbert DMD
Louisville, KY
01.2011 - 05.2015
- Processed patient intake information and updated medical records prior to treatment.
- · Scheduled evaluations and procedures for patients.
- · Communicated with patients to ensure quality of care and develop care plans.
- · Completed insurance verifications and claim forms for patient intake and processing.
- · Provided administrative support for patient care staff.
- · Liaised effectively with patients, doctors, and staff members, assessing medical charts, and promoting high level of communication and interaction.
- · Demonstrated flexibility during changes to patient care practice.
- · Troubleshot and resolved complex customer service issues to enhance patient and family experience.
- · Established a strong work network by building professional relationships with physicians and fellow employees.
- Compiled and maintained medical charts and reports in complex digital databases.
Administrative Assistant
Home School Vendors Association
Louisville, KY
05.2009 - 01.2011
- · Answered phone calls and emails to provide information, resulting in effective business correspondence.
- · Provided secretarial and office management support while building cooperative working relationships.
- · Inventoried and ordered supplies for office.
- · Scheduled appointments, meetings, and events for management staff.
- · Responded effectively to sensitive inquiries or complaints.
- · Coordinated appointments, meetings, and conferences.
- · Maintained accurate department and customer records.
- · Managed physical and digital files, monitored spreadsheets and updated reports to coordinate project materials.
- · Prepared and prioritized calendars and correspondence.
- Organized both physical and digital files and updated reports to coordinate project materials.
Receptionist
The Color Place, INC
Louisville, KY
12.2006 - 04.2009
- · Answered phone calls and emails to provide information, resulting in effective business correspondence.
- · Provided secretarial and office management support while building cooperative working relationships.
- · Inventoried and ordered supplies for office.
- · Scheduled appointments, meetings, and events for management staff.
- · Responded effectively to sensitive inquiries or complaints.
- · Coordinated appointments, meetings, and conferences.
- · Maintained accurate department and customer records.
- · Managed physical and digital files, monitored spreadsheets and updated reports to coordinate project materials.
- · Developed administrative processes to achieve organizational objectives and improve office efficiency.
- · Prepared and prioritized calendars and correspondence.
- · Organized both physical and digital files and updated reports to coordinate project materials.
- · Directed customer communication to appropriate department personnel.
- · Composed correspondence, reports, and meeting notes.
- Utilized editing programs to proofread content for typo-free emails, memos, and documentation
Education
High School Diploma -
Eastern High School
Louisville, KY05-2005
Skills
- Insurance information oversight
- Billing Procedures
- Precertification requirements
- Workflow Management
- Insurance Verification
- Data Entry
- Critical thinking abilities
- Patient Scheduling
- Effective communication skills
- Advanced MS Office Suite Knowledge
- Excel Spreadsheets
- Meeting Planning
- Timeline Planning and Management
- Data Entry Documentation
- Professional and Courteous
- Verbal and Written Communication
- Confidentiality and Data Protection
- Appointment Coordination
- Document and File Management
- Multi-Line Telephone Systems
- Strong Organizational Skills
- Meticulous Attention to Detail
- Task Prioritization
- Microsoft Office
- Multitasking and Time Management
- Schedule Management
Timeline
Prior Authorization Specialist
Norton Health Care
01.2024 - Current
Administrative Assistant
Quantum Shopping Solutions
09.2022 - 01.2024
Patient Care Coordinator
OptumRx
07.2018 - 09.2022
Customer Ser
Humana
09.2015 - 12.2017
Office Manager
Dr. R. Clay Gilbert DMD
01.2011 - 05.2015
Administrative Assistant
Home School Vendors Association
05.2009 - 01.2011
Receptionist
The Color Place, INC
12.2006 - 04.2009
High School Diploma -
Eastern High School
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