KELLY HARDING
Farmington,New Mexico
Summary
Healthcare professional with over ten years of experience in patient intake, insurance verification, eligibility determination, referral coordination, prior authorization specialist and EPIC EHR documentation. Processed high-volume work queues (90–100 patients daily) and completed new patient registrations (20+ per day) for Nephrology and Endocrinology specialty clinics. Skilled in CPT/ICD-10 coding, benefits coordination, HIPAA compliance, and updating demographic and insurance data to support accurate billing and improved patient access.
Overview
8
8
years of professional experience
Work History
Referral and Eligibility Coordinator
Pinnacle Healthcare
09.2024 - 01.2025
- Ensured the quality, accuracy, and completeness of patient demographic information, maintaining data integrity.
- Streamlined pre-visit processes by proactively verifying eligibility, coordinating benefits, and obtaining all required referrals and authorizations.
- Managed a high-volume daily work queue, completing 90–100 new patient demographic intakes for a specialty clinic requiring PCP referrals.
Pre-Certification Specialist
New Mexico Orthopaedics
12.2023 - 03.2024
- Successfully processed a high volume of timely benefits verifications and prior authorizations for diverse physician and physical therapy specialties.
- Obtained eligibility and prior authorizations for DME, assigned surgeries and outside testing and physical therapy.
- Coordinated with Front Office, Medical Records, Medical Assistants, and Account Representatives to manage and reconcile critical patient data.
Patient Care Coordinator
University of New Mexico Hospital
09.2023 - 12.2023
- Coordinated appointments and administrative support services, optimizing scheduling and operational efficiency for the department and physicians.
- Conducted pre-screening for specialty clinic appointments, ensuring all necessary referrals and prior authorizations were secured.
- Accessed and compiled critical patient information, including historical records, billing data, referrals, and lab results, for efficient case management.
Utilization Management Representative
iCare Health
10.2022 - 03.2023
- Processed a high volume of prior authorization requests, consistently upholding internal policies and procedural guidelines.
- Facilitated clear communication of approved outpatient surgical procedures to medical providers and health plan members, supporting coordinated care.
- Maintained comprehensive logs, records, and reports in adherence to Utilization Management department guidelines.
Patient Access Representative
Presbyterian Hospital
08.2021 - 08.2022
- Managed patient registration processes for the Emergency Department, ensuring accuracy and efficiency.
- Organized and managed patient discharge documents, health histories, and admission paperwork, ensuring accuracy and compliance.
- Advocated for members, resolving complex issues with practitioners, facilities, billing departments, and employer groups to ensure optimal outcomes.
Prior Authorization Representative/ER Clerk
UNM Sandoval Regional Medical Center
06.2017 - 07.2021
- Secured timely pre-authorizations from insurance companies for outpatient radiology procedures, verifying medical necessity and coverage to prevent claim denials.
- Managed comprehensive communication with patients, physicians, and other healthcare professionals, ensuring accurate information gathering, prompt resolution of questions, and timely dissemination of authorization status updates.
- Documented authorization requests, approvals, and denials with associated patient information, ensuring data accuracy crucial for patient care and administrative processes.
Education
Associate of Arts - Integrated Studies, Health Wellness and Public Safety Certificate
Central New Mexico Community College
Albuquerque, N.M.08.2020
High School Diploma -
Navajo Pine High School
Navajo, N.M.05.2006
Skills
- Medical terminology
- Medical coding (ICD-10, CPT, HCPCS)
- Insurance verification
- Insurance Policies & Payer Guidelines
- EHR/EMR Systems (EPIC, Cerner, ClearWave)
- Payer portals and Authorization software
- Documentation management
- Denial management & appeals
- Healthcare Revenue Cycle Management
- HIPAA Compliance
- Computer Proficiency
Accomplishments
- Achieved a high approval rate for outpatient radiology procedures by accurately and efficiently processing STAT orders during the COVID-19 pandemic, despite overwhelming request volumes.
ADDITIONAL EXPERIENCE
- Respite Provider, Alta Mira Jun 2015 - May 2018
- Assisted children with disabilities with daily living activities (e.g., bathing, dressing, feeding, medication administration), as needed and outlined in a care plan.
- Ensured the safety and security of the individual, preventing accidents, and responding to emergencies.
- Provided companionship, engaging in recreational activities, and offering emotional support.
- Caregiver, Albuquerque Home Healthcare Jan 2013 - Aug 2013
- Assisted with Activities of Daily Living (ADLs) such as bathing, dressing, grooming, toileting, and mobility (e.g., transferring, walking assistance).
- Reminded and assisted with medication administration, ensured proper dosage and schedule, and monitored for side effects.
- Provided social interaction, engaged in activities (e.g., reading, games, conversation), and offered emotional encouragement to combat loneliness and isolation.
Timeline
Referral and Eligibility Coordinator
Pinnacle Healthcare
09.2024 - 01.2025
Pre-Certification Specialist
New Mexico Orthopaedics
12.2023 - 03.2024
Patient Care Coordinator
University of New Mexico Hospital
09.2023 - 12.2023
Utilization Management Representative
iCare Health
10.2022 - 03.2023
Patient Access Representative
Presbyterian Hospital
08.2021 - 08.2022
Prior Authorization Representative/ER Clerk
UNM Sandoval Regional Medical Center
06.2017 - 07.2021
Associate of Arts - Integrated Studies, Health Wellness and Public Safety Certificate
Central New Mexico Community College
High School Diploma -
Navajo Pine High School