Summary
Work History
Education
Skills
Timeline
Generic

Kelsey Birely

Gloucester City,US

Summary

Manager of Ambulatory Operations with a robust foundation in healthcare management and customer service excellence. Adept at optimizing workflows, enhancing team collaboration, and maintaining regulatory compliance, while fostering professional development and resource optimization. Demonstrates a commitment to driving patient-focused service excellence and implementing process improvements across multi-site operations for enhanced patient and operational outcomes.

Work History

LEAD ONCOLOGY SR. PRECERTIFICATION SPECIALIST

Fox Chase Cancer Center
  • Obtain pre-certifications and authorizations for outpatient and surgical procedures
  • Coordinate patient referrals and assist with hospital admissions
  • Analyze and resolve barriers to authorization and information validation
  • Review insurance claims and process referrals per plan requirements
  • Communicate authorization status and delays to medical staff
  • Cultivated strong relationships with medical staff to ensure smooth communication of authorization statuses, enhancing team collaboration.
  • Streamlined the pre-certification process, significantly reducing turnaround times and improving patient admission rates.
  • Conducted thorough analyses of authorization barriers, implementing solutions that led to noticeable improvements in claim approvals.
  • Coordinated with insurance providers and healthcare professionals to facilitate timely referrals, fostering a patient-centered approach.
  • Communicated complex authorization requirements clearly to medical staff, ensuring compliance and reducing delays in patient care.
  • Fostered collaborative relationships with medical staff to streamline communication about authorization statuses, enhancing team efficiency.

CASH POSTER/ CUSTOMER SERVICE REPRESENTATIVE/FINANCIAL COUNSELOR

Thomas Jefferson University
  • Efficiently post insurance payments, resolving account issues for patient satisfaction.
  • Assist patients with financial responsibilities, ensuring clarity and support in billing.
  • Monitor and adjust account details, optimizing coding for accurate billing processes.
  • Provided empathetic assistance to patients, fostering trust and ensuring a positive experience in navigating financial responsibilities.
  • Processed insurance payments efficiently, reducing account discrepancies and enhancing the accuracy of financial records.
  • Engaged with insurers to resolve patient account issues, strengthening communication channels and improving resolution times.
  • Monitored accounts closely to ensure compliance with financial expectations, leading to improved cash flow and reduced outstanding balances.
  • Adjusted diagnosis and CPT coding accurately, maintaining compliance and optimizing reimbursement processes for the organization.
  • Provided empathetic assistance to patients, ensuring clarity in billing and fostering trust during financial discussions.

MANAGER OF PRIOR AUTHORIZATION OPERATIONS

- Current
  • Oversee multi-site operations, boosting efficiency and enhancing patient care outcomes.
  • Enhance physician-staff collaboration, improving communication and patient service quality.
  • Optimize staffing and resources, reducing patient wait times and improving service delivery.
  • Address workflow bottlenecks, increasing processing speed and patient satisfaction.
  • Develop onboarding programs, fostering continuous learning and staff development.
  • Streamlined prior authorization processes, achieving substantial improvements in approval timelines and reducing delays in patient services.
  • Analyzed workflow metrics to identify inefficiencies, implementing data-driven solutions that enhanced operational performance and service delivery.
  • Introduced new technology for tracking authorizations, resulting in improved accuracy and efficiency in handling patient requests.
  • Facilitated cross-departmental meetings to align goals and strategies, strengthening team unity and driving collective success in patient care.
  • Fostered a culture of continuous learning, enhancing team engagement and ensuring staff remained updated on industry best practices.
  • Streamlined prior authorization workflows, leading to noticeable gains in approval timelines and minimizing service delays.
  • Overturn 65% of denied claims, significantly increasing annual revenue.
  • Classify contracted and non-contracted provider appeals according to federal and state regulations, as well as internal and organizational policies and procedures.
  • Submitted medical necessity appeals to health plans within the appropriate timeframe for timely filing.

Ambulatory Business Operations Manager

Princeton Medical Group
Princeton, NJ
01.2026 - Current
  • Streamlined operational workflows to enhance patient care efficiency across departments.
  • Implemented data analysis tools to improve resource allocation and decision-making processes.
  • Developed training programs for staff to ensure adherence to compliance standards and best practices.
  • Collaborated with cross-functional teams to identify opportunities for process improvements and cost reductions.
  • Led initiatives to optimize scheduling systems, reducing wait times for patients significantly.
  • Analyzed performance metrics to drive strategic planning and operational adjustments in service delivery.
  • Managed vendor relationships to negotiate contracts that improved service quality while controlling costs.
  • Facilitated team meetings focused on continuous improvement strategies, fostering a culture of collaboration and innovation.
  • Reviewed company's strategic plans and developed departmental goals and standards to support vision.
  • Streamlined business processes by analyzing current procedures and implementing necessary improvements.
  • Increased overall efficiency by automating repetitive tasks and optimizing workflow.
  • Oversaw day-to-day business operations on sales floor by fostering deep professional relationships with wholesale contacts and customers.
  • Implemented escalation procedures to effectively handle time-sensitive issues.
  • Oversaw financial management, ensuring accurate forecasting, budgeting, and reporting to support informed decisionmaking.
  • Ensured compliance with industry regulations by developing robust policiesprocedures.
  • Trained new hires, providing information, and insight into corporate policies and procedures.
  • Spearheaded change management initiatives to successfully integrate new processes or technologies into existing operations.
  • Established performance metrics to evaluate team effectiveness and identify opportunities for improvement.
  • Developed strategic partnerships with key stakeholders, fostering collaboration and driving growth.
  • Managed pharmacy operations, ensuring compliance with regulations and safety standards.
  • Oversaw inventory management, optimizing stock levels to enhance service delivery.

Education

ASSOCIATES - Anthropology, Applied Health Science, Sociology, Developmental Psychology, World Literature, and World History

Rowan College of Burlington County

BACHELOR OF SCIENCE -

Wilmington University
09-2027

ASSOCIATES - Applied Health Science

Rowan University

BACHELORS OF LIBERAL ARTS AND SCIENCE - undefined

Wilmington University

undefined

Thomas Jefferson University
01-2017

Skills

  • Operations Management, Patient Experience, Regulatory Compliance, Resource Optimization, Staff Supervision, Process Improvement, Data Analysis, Strategic Planning, Facility Management, Professional Development, Leadership, Communication, Problem-Solving, Teamwork, Results Achievement

Timeline

Ambulatory Business Operations Manager

Princeton Medical Group
01.2026 - Current

LEAD ONCOLOGY SR. PRECERTIFICATION SPECIALIST

Fox Chase Cancer Center

CASH POSTER/ CUSTOMER SERVICE REPRESENTATIVE/FINANCIAL COUNSELOR

Thomas Jefferson University

MANAGER OF PRIOR AUTHORIZATION OPERATIONS

- Current

ASSOCIATES - Applied Health Science

Rowan University

BACHELORS OF LIBERAL ARTS AND SCIENCE - undefined

Wilmington University

undefined

Thomas Jefferson University

ASSOCIATES - Anthropology, Applied Health Science, Sociology, Developmental Psychology, World Literature, and World History

Rowan College of Burlington County

BACHELOR OF SCIENCE -

Wilmington University

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Kelsey Birely