Kaylah Youmans
Columbia,SC
Summary
Detail-oriented Medical Billing and Prior Authorization Specialist with 5+ years of experience streamlining pre-approval workflows, verifying patient eligibility, and reducing claim denials. Proven track record of accelerating approval turnaround times, recovering lost revenue through targeted appeals, and maintaining strict compliance with HIPAA and payer guidelines.
Overview
1
1
Certification
6
6
years of professional experience
Work History
Eligibility Specialist
South Carolina Department of Health and Human Services
Columbia, SC
10.2025 - Current
- Collecting and evaluating applicant documentation and information to ensure compliance with federal and state policies.
- Maintaining accurate case files, verifying household information, and communicating with applicants and other parties.
- Determine and re-determine Medicaid and other public program eligibility based on Modified Adjusted Gross Income (MAGI) rules and established policies.
- Conduct follow up activities efficiently to gather missing information and resolve any discrepancies in applications
- Answer phone calls for returned mail cases and update case information accordingly.
- Make collateral calls for requested additional information for applicants.
- Writing acceptance and rejection notices.
Eligibility Specialist
TEKsystems (Contractor)
Columbia, SC
04.2024 - 10.2025
- Collecting and evaluating applicant documentation and information to ensure compliance with federal and state policies.
- Maintaining accurate case files, verifying household information, and communicating with applicants and other parties.
- Determine and re-determine Medicaid and other public program eligibility based on Modified Adjusted Gross Income (MAGI) rules and established policies.
- Conduct follow up activities efficiently to gather missing information and resolve any discrepancies in applications
- Answer phone calls for returned mail cases and update case information accordingly.
- Make collateral calls for requested additional information for applicants.
- Writing acceptance and rejection notices.
Physicians Support Unit Rep I
Evicore Healthcare
Bluffton, SC
01.2021 - 03.2024
- Promptly transfer calls that cannot be completed via the formal script to a clinical reviewer for completion.
- Investigate and resolve any pre-certification questions or concerns.
- Provide professional, courteous and accurate information to all callers.
- Manages incoming communications from medical offices.
- Assists with prior authorization inquiries, and schedules peer-to-peer clinical consultations.
- Educate medical staff on health plan requirements, clinical guidelines, reconsideration criteria, and appeal policies.
- Assess denied or pending cases to explain available post-decision options to provider offices.
Education
Bachelor of Science - Sociology
Lander University
Greenwood, SC05-2017
Skills
- Medical Terminology: Read patient charts and understand diagnoses, treatments, and procedures
- Medical Coding: Use CPT, HCPCS, and ICD-10 codes to match treatments with correct billing guidelines
- Insurance Knowledge: Navigate policies for Medicare, Medicaid, HMOs, and PPOs
- Software Proficiency: Use Electronic Health Records (EHR), insurance payer portals, and specialized authorization platforms
- Knowledge of compliance standards like HIPAA for healthcare billers or specific insurance policies
- Data Entry & Math: High typing accuracy and foundational math skills to document financial records
Organizations
- Student Support Services
- Chi Sigma Christian Sorority
- Visions of Women
- Sociology Club
Certification
Pharmacy Technician License, September 2019, Medication Technician License, October 2018, CPR (The American Red Cross), November 2017
Timeline
Eligibility Specialist
South Carolina Department of Health and Human Services
10.2025 - Current
Eligibility Specialist
TEKsystems (Contractor)
04.2024 - 10.2025
Physicians Support Unit Rep I
Evicore Healthcare
01.2021 - 03.2024
Bachelor of Science - Sociology
Lander University