KEILEI HOUSTON
Pontiac
Summary
Detail-oriented operations professional with a track record of managing authorization processes and ensuring compliance. Known for maintaining high-quality standards and achieving exceptional performance metrics, including 100% evaluations. Proficient in leveraging data analysis and workflow tools to enhance operational effectiveness and stakeholder communication.
Overview
16
16
years of professional experience
Work History
AUTHORIZATION INTAKE SPECIALIST / GMI COORDINATOR
W3R Consulting
03.2025 - Current
- Built, reviewed, and managed authorization cases by collecting and organizing clinical documentation from hospitals, facilities, physicians, and healthcare providers to ensure compliance with medical necessity requirements.
- Contacted hospitals and healthcare facilities to obtain clinical documentation for timely medical necessity review and authorization determinations.
- Supported utilization management workflows by gathering and validating essential information for nurse review and authorization decisions, contributing to streamlined operations.
- Maintain quality review scores ranging from 95%-100% while supporting high-volume authorization workflows.
- Achieved a 100% performance evaluation score through consistent accuracy, compliance, productivity, and attention to detail.
- Average 46 completed cases per day while maintaining documentation quality and compliance standards.
- Utilize Microsoft Excel, reporting dashboards, and workflow tracking tools daily.
- Collaborate with nurses, providers, hospitals, facilities, and internal stakeholders.
- Supporting Blue Cross Blue Shield of Michigan
INSURANCE VERIFICATION SPECIALIST
True Gynecology
Troy
04.2023 - 03.2025
- Conducted insurance verification and eligibility reviews, providing authorization support and thorough documentation analysis to ensure compliance.
- Investigated and resolved account discrepancies by collaborating with patients, providers, and insurance carriers, enhancing overall accuracy in accounts.
- Created operational reports and monitored account activity to identify trends and support decision-making.
SENIOR PATIENT ACCESS REPRESENTATIVE
Conifer Health Solutions
Commerce Township
10.2014 - 03.2021
- Managed patient registration, insurance verification, financial counseling, and payment collection activities for over [X] patients weekly, ensuring streamlined operations and enhanced patient satisfaction.
- Earned Operational Excellence Awards for outstanding performance in point-of-service collections, reflecting commitment to financial accuracy and patient care.
- Facilitated onboarding and training for new team members, contributing to a supportive work environment and improving team integration.
SENIOR PATIENT ACCESS REPRESENTATIVE (CONTRACT)
Henry Ford Hospital
Detroit
10.2013 - 10.2014
SENIOR MEDICAL RECEPTIONIST / BILLING SPECIALIST
Associated Dermatologists of West Bloomfield
West Bloomfield
05.2010 - 10.2010
Education
Bachelor of Arts - Healthcare Administration & Management
University of Phoenix
Associate of Science -
Oakland Community College
Auburn Hills, MichiganSkills
- Authorization processing
- Insurance verification
- Eligibility review
- Claims processing
- Utilization review
- Clinical documentation
- Case management
- Patient registration
- Records management
- Workflow management
- Workflow tracking
- Data Analysis
- Operational reporting
- Dashboard reporting
- Microsoft Excel
- Microsoft Office Suite
- Outlook
- Microsoft Teams
- Data entry
- Documentation systems
- Records management
- Records maintenance
- Intake assessment
- Problem solving
- Critical thinking
- Adaptability
- Follow-up skills
- Collaborative teamwork
- Empathetic communication
- Empathetic communication
- Collaborative teamwork
Accomplishments
- Achieved a 100% performance evaluation score, 01/01/26
- Maintained quality review scores ranging from 95%-100%
- Averaged 46 completed cases per day while maintaining compliance and quality standards
- Recipient of multiple Operational Excellence Awards
- Assisted with onboarding and training support for new team members
- Daily user of Microsoft Excel, reporting dashboards, workflow tracking systems, and productivity monitoring tools
Timeline
AUTHORIZATION INTAKE SPECIALIST / GMI COORDINATOR
W3R Consulting
03.2025 - Current
INSURANCE VERIFICATION SPECIALIST
True Gynecology
04.2023 - 03.2025
SENIOR PATIENT ACCESS REPRESENTATIVE
Conifer Health Solutions
10.2014 - 03.2021
SENIOR PATIENT ACCESS REPRESENTATIVE (CONTRACT)
Henry Ford Hospital
10.2013 - 10.2014
SENIOR MEDICAL RECEPTIONIST / BILLING SPECIALIST
Associated Dermatologists of West Bloomfield
05.2010 - 10.2010
Bachelor of Arts - Healthcare Administration & Management
University of Phoenix
Associate of Science -
Oakland Community College