Kelly Trotochaud
Moodus
Summary
Dynamic leader with extensive experience in training, mentoring, and staff management within healthcare case management. Skilled in implementing process improvements that enhance workflow efficiency and compliance, driving significant improvements in customer satisfaction and team productivity.
Overview
10
10
years of professional experience
Work History
Supervisor, Prior Authorization Case Management
Guided Care
Lakewood, NJ
01.2023 - Current
- Trained and mentored team members to enhance performance and productivity.
- Implemented process improvements that streamlined workflows and reduced turnaround time.
- Conducted performance evaluations, identifying areas for improvement and growth opportunities for staff.
- Facilitated communication between teams to enhance collaboration and problem-solving efforts.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Demonstrated commitment to the organization''s core values, leading by example and fostering a culture of excellence.
- Proficient in managing NRD processes
- Maintain clinical documentation standards to support the DENC, specifically addressing required clinical changes for repeat discharge attempts
- Administer CMS NOMNC/DENC notices, ensuring 100% compliance with revised fast track appeal rights for Medicare Advantage enrollees
- Skilled in coordinating with QIO ( Acentra Health or Livanta) for expedited reviews, managing both timely and untimely appeal submissions
Prior Authorization Specialist
Connecticut GI
Rocky Hill, CT
09.2019 - 12.2022
- Reviewed and processed prior authorization requests, ensuring compliance with insurance guidelines.
- Collaborated with healthcare providers to gather necessary documentation for approval processes.
- Analyzed complex patient cases to determine eligibility for procedures and treatments.
- Streamlined workflows by implementing best practices in prior authorization submissions.
- Developed training materials to enhance team understanding of authorization protocols and policies.
- Utilized electronic medical records systems to track and manage authorization statuses efficiently.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
Prior Authorization Specialist
Hartford Hospital Pain Treatment Center
West Hartford, CT
08.2016 - 09.2019
- Mentored junior staff on effective communication with insurance companies and providers.
- Led initiatives to reduce turnaround times for prior authorization approvals across departments.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
Education
High School Diploma -
Abington High School
Abington, MASkills
- Training and mentoring
- Goal oriented
- Staff management
- Customer service
- EMR
- NOMNC
- QIO Appeals
- High Cost Medication Carveouts
Timeline
Supervisor, Prior Authorization Case Management
Guided Care
01.2023 - Current
Prior Authorization Specialist
Connecticut GI
09.2019 - 12.2022
Prior Authorization Specialist
Hartford Hospital Pain Treatment Center
08.2016 - 09.2019
High School Diploma -
Abington High School