Kelly Heginbotham
Youngstown
Summary
Dynamic and results-driven professional with over 12 years of experience as a prebilling specialist, specializing in data entry, insurance verification, eligibility and benefits, and prior authorizations. Expertise in collaborating with insurance companies and healthcare providers to deliver exceptional customer service, gained through roles at Youngstown Orthopaedic and Quadax Inc. Proficient in navigating insurance portals and communicating effectively with healthcare providers to ensure seamless medical coverage. A strong foundation in operational management and customer service developed through previous roles in merchandising at The Home Depot and as Store Manager at Electric Beach Tanning Salon, enhancing the ability to lead teams and drive results.
Overview
25
25
years of professional experience
Work History
Insurance Verification Specialist
Youngstown Orthopaedic Associates
Boardman, OH
01.2025 - Current
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Coordinated with healthcare providers to obtain accurate eligibility and benefit details, enhancing patient experience prior to appointments and procedures.
- Reviewed and revised patient records to reflect the most current an accurate insurance policy information to reduce billing errors
- Proficient in navigating insurance payer portals to obtain fast information to insurance plans
- Communicating between medical staff and patients by explaining insurance benefits and financial responsibilities.
- Coordinated and managed patient authorization requests to ensure prompt access to services.
- Managed high-volume insurance verifications, while assisting our 2 urgent care locations, and promptly responding to heavy flow of emails
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
- Guided new employees through insurance verification protocols to ensure compliance and accuracy in operations.
- Maintained up-to-date knowledge of insurance policies and procedures to enhance verification processes.
- Assisted our billing team in addressing COB issues and discrepancies to streamline claims processing.
Pre-Billing Specialist
Quadax, Inc.
Boardman, OH
02.2015 - 06.2024
- 9 plus years of experience working in roles of Data Verification, Eligibility & benefits, Prior Authorizations, & Fax inbound. These roles include communicating with insurance companies and healthcare providers to provide excellent customer service to deliver accuracy of insurance plan coverages.
- Knowledge and experience working many insurance portals to verify coverage online.
- Trained many new hires individually and remotely
- Ability to multi task, hit target dates, and hit daily productivity goals.
- Researched and resolved billing discrepancies to enable accurate billing.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
- Organized and indexed medical records to ensure accurate departmental access.
- Coordinated efforts to secure necessary prior authorizations to streamline appointment scheduling.
Merchandising Execution Team
The Home Depot
Austintown, OH
10.2012 - 02.2015
- Achieved optimal store layout through effective management of team and individual resets. Improved product visibility by maintaining accurate planograms. Enhanced store presentation by performing regular bay maintenance. Elevated customer satisfaction by providing outstanding service.
- Executed merchandising strategies to enhance product visibility and drive customer engagement.
- Coordinated team collaboration and executed independent assignments effectively and proficiently.
- Ensured meticulous attention to detail in assignment completion.
- Utilized strong organizational and time management abilities to effectively execute store planograms and multiple projects.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Oversaw inventory management processes to ensure optimal stock levels.
Store Manager
Electric Beach Tanning Salon
Boardman, OH
10.2001 - 09.2012
- Oversaw client consultations to develop tailored tanning strategies based on individual skin types. Directed staff in appointment scheduling and optimized daily cash handling procedures. Resolved customer issues effectively while ensuring salon cleanliness standards were met. Led promotional efforts for tanning packages and enhanced product sales. Managed weekly staff scheduling and payroll functions to ensure operational efficiency. Executed opening and closing procedures for salon operations.
- Directed daily operations to optimize customer service and enhance salon experience.
- Trained and mentored staff on best practices for sales and client interactions.
- Addressed customer complaints promptly and professionally, resolving issues to maintain positive relationships with clientele.
- Managed daily operations to ensure smooth functioning of the store, maintaining a clean, safe environment for customers and employees.
- Approved regular payroll submissions for employees.
Education
High school diploma -
Cardinal Mooney High School
Youngstown, OH06-2001
Skills
- Data entry
- Insurance verification
- Prior authorization processing
- HIPAA compliance
- Scheduling
- Customer service
- Communication skills
- Attention to detail
Timeline
Insurance Verification Specialist
Youngstown Orthopaedic Associates
01.2025 - Current
Pre-Billing Specialist
Quadax, Inc.
02.2015 - 06.2024
Merchandising Execution Team
The Home Depot
10.2012 - 02.2015
Store Manager
Electric Beach Tanning Salon
10.2001 - 09.2012
High school diploma -
Cardinal Mooney High School