Kelsey Griffin
London,KY
Summary
Reliable professional offering an extensive career promoting positive customer experiences. Sharp Eligibility Specialist boasting expertise in managing and eligibility information for members and groups.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Verification of Benefits Specialist
Prosperity Behavioral Health
Remote
06.2023 - Current
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Updated patient records with accurate, current insurance policy information.
- Established and maintained relationships with insurance providers for productive communications.
- Communicated verification and authorization status updates with Type department to facilitate decision-making for patient admissions and insurance coverage.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Generated reports to track insurance verifications and claim progress.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Trained new staff on current, correct insurance verification procedures.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Determined appropriateness of payers to protect organization and minimize risk.
Insurance Verification Specialist
Becton Dickinson
London, KY
05.2022 - 06.2023
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Observed strict procedures to protect sensitive patient information, medical records and payment data.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Received, recorded and addressed incoming and outgoing communication via telephone and email.
- Determined appropriateness of payers to protect organization and minimize risk.
Authorization Coordinator
R1 RCM- Ascension Health
Chicago, Illinois
05.2021 - 09.2022
- Reviewed authorizations from payer to determine approved or denied items.
- Reviewed documentation for accuracy and assessment of necessity.
- Submitted for prior authorization with required documentation to appropriate funding source.
- Maintained consistent follow-up on status of prior authorization requests.
- Typed acknowledgment letters to persons sending correspondence.
- Maintained files and controlled records to show correspondence activities.
- Prepared documents and correspondence such as damage claims, credit and billing inquiries and service complaints.
- Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.
- Read incoming correspondence to ascertain nature of writers' concerns and to determine disposition of correspondence.
- Completed form letters in response to requests or problems identified by correspondence.
- Edited letters and written material for correspondence.
- Calculated estimated copay based on current insurance benefits.
Eligibility Specialist
Kemberton Health Services
Manchester Center, KY
11.2020 - 04.2021
- Called applicants to set up appointments and explain benefits processes.
- Analyzed information from interviews, educational, and medical records, consultation with other professionals and diagnostic evaluations to assess clients' abilities, needs and eligibility for services.
- Inputted all communication with applicants into computer system to facilitate future clarification and knowledgeable support.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Conducted interviews with applicants, explaining benefits process and which programs were available.
- Reviewed criteria for different state aid programs to determine eligibility for various applicants.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
Corporate Trainer
Senture
10.2019 - 11.2020
- Boosted confidence of employees by providing skilled training to improve knowledge and productivity.
- Educated team members on time and resource management to improve organizational efficiency and control costs.
- Reduced process lags and effectively trained team members on best practices and protocol.
- Scheduled training sessions based on availability of classrooms, equipment and instructors.
- Evaluated client processes, employee performance and training progress to determine additional training needs.
- Created practice exams, exercise documents and interactive videos from older content and transferred print materials to digital.
- Leveraged simulations, team exercises and group discussions to increase training program engagement.
- Administered course content, schedules and attendance utilizing learning management system (LMS).
- Designed and directed orientation and training programs to meet client needs.
- Blended business's goals, mission and values with learning development initiatives to deliver high-quality training to employees.
Collector
OneMain Financial Inc.
07.2018 - 04.2019
- Applied training and persuasive communication strategies to overcome objections.
- Contacted customers to discuss payment schedules and set up or immediately process payments.
- Collected on past due accounts with average 1-3 months delinquency.
- Worked in call center environment handling manual and automatically dialed outbound calls.
- Trained new team members on scripts, company services and performance strategies and provided mentoring.
- Maintained compliance with fair debt practices and regulatory guidelines.
- Negotiated with account holders to devise repayment plans and minimize collections receivables.
- Recovered lost revenue by persistently reaching out to customers with past due accounts.
- Reached out to customer to pursue payments, remind of obligations and discuss default procedures.
- Evaluated customer accounts to determine adherence to repayment schedules.
- Conveyed current account information and obtained payments by using pre-scripted statements.
- Followed fair debt practices and regulatory guidelines when managing collections process.
- Overcame objections by applying advanced training and persuasion techniques.
- Remained calm, stayed professional and provided exceptional service on all calls, even when interacting with difficult individuals.
Certified Patient Access Representative
Manchester Memorial Hospital
01.2014 - 07.2018
- Maintained correct information for patients entering facility for outpatient procedures. Such as: address, phone number, insurance information, and emergency contacts.
- Scanned in orders written from doctors into Citrix software using Power Chart and Cerner.
- Ability to use Microsoft Windows 10 and other Microsoft software including Excel, PowerPoint, Word, and Outlook confidently and accurately.
- Ability to use and maintain all office equipment including fax machine, printer, scanner, computers, paging system, code blue system, telephone, and switchboard.
- Proficient in reading doctors orders for lab procedures, radiology, and respiratory.
- Proficient in communicating with various insurance companies in order to obtain pre-authorizations for lab and radiology tests.
- Juggled multiple projects and tasks to ensure high quality and timely delivery
- Demonstrated self-reliance by meeting and exceeding workflow needs
- Provided excellent service and attention to customers when face-to-face or through phone conversations
Shift Leader
Speedway LLC
07.2011 - 04.2014
- Worked night and weekend shifts during holiday season.
- Conducted routine inspections of incoming materials to check quality and compliance with established product specifications.
- Maintained clean and well-organized production areas to avoid violations or unnecessary work delays due to hazards or inefficient layouts.
- Assigned daily tasks to employees and monitored activity and task completion.
- Coached team members in techniques necessary to complete job tasks.
- Worked with management team to implement proper division of responsibilities.
- Recommended alternative items when product was out of stock.
Surgery Scheduler
Grace Health
Corbin, KY
03.2024 - Current
- Educated patients on pre-surgery requirements, such as fasting protocols or medication adjustments, resulting in fewer complications on the day of the procedure.
- Handled urgent requests effectively, prioritizing cases requiring immediate attention while also balancing routine surgery demands appropriately.
- Arranged pre-operative and post-operative appointments for surgical patients.
- Expertly managed planning, scheduling, and coordination of outpatient procedures.
- Verified insurance coverage and obtained pre-authorizations.
- Maintained strict confidentiality in handling sensitive patient information, adhering to HIPAA guidelines and clinic policies.
- Took pre-operative orders from surgeons and anesthesiologists for smooth operation planning.
- Obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
- Demonstrated adaptability in managing last-minute schedule changes while minimizing disruption to overall workflow.
- Resolved scheduling conflicts to maintain high-quality patient services.
- Acted as a liaison between patients, insurance carriers, and the surgical team to secure necessary authorizations for timely procedures.
- Organized all necessary documentation for successful completion of medical audits related to surgery scheduling practices.
- Updated patient records to reflect upcoming surgeries and medical histories.
- Coordinated surgical team schedules for seamless procedure planning and execution.
- Elevated patient experience by providing empathetic support throughout the entire surgical journey-from initial consultation to post-operative follow-up appointments.
Education
Some College (No Degree) - Medical Insurance Billing
Somerset Community College
Somerset, KYSkills
- Patient-focused care
- Trustworthy companion
- CHAA certification
- Confident
- Trained in clinical administrative duties
- Document scanning
- Insurance coverage verification
- Data entry
- Proficient in using Microsoft systems
- Proficient in using KYMMIS
- Proficient in obeying HIPAA and OSHA regulations
- Applicant support and service
- Program understanding and advisement
- Advocacy and Counseling
- Application assessment
- Telephone etiquette
- Organizational skills
- Recordkeeping and data input
- Customer service
- MS Office
- Microsoft Office
- Time management
- Communication
- Multitasking
Certification
- Certified Healthcare Access Associate certification through The National Association of Healthcare Access Management
Timeline
Surgery Scheduler
Grace Health
03.2024 - Current
Verification of Benefits Specialist
Prosperity Behavioral Health
06.2023 - Current
Insurance Verification Specialist
Becton Dickinson
05.2022 - 06.2023
Authorization Coordinator
R1 RCM- Ascension Health
05.2021 - 09.2022
Eligibility Specialist
Kemberton Health Services
11.2020 - 04.2021
Corporate Trainer
Senture
10.2019 - 11.2020
Collector
OneMain Financial Inc.
07.2018 - 04.2019
Certified Patient Access Representative
Manchester Memorial Hospital
01.2014 - 07.2018
Shift Leader
Speedway LLC
07.2011 - 04.2014
Some College (No Degree) - Medical Insurance Billing
Somerset Community College