Kelsey Loya
Round Rock
Summary
Supported customer satisfaction initiatives by implementing effective solutions to healthcare challenges. Assisted team members in adapting to fast-paced environments to improve overall performance. Contributed skills and experience to enhance organizational success.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Pre-Authorization Specialist
Pain Specialists of America
Austin
10.2025 - 01.2026
- Responsible for making sure medical necessity is meet
- Checking chart and confirming a covered DX is in file.
- Contacting providers/payers and submitting requests with supporting clinical data.
- Keeping track of approvals/denials, and ensuring coverage for treatments
- Handling any other side jobs that may come up and answering teams messages from the clinic or provider as needed.
- Processed patient authorizations efficiently to ensure timely care delivery.
- Coordinated with insurance providers to verify coverage and eligibility for treatments.
- Reviewed complex cases, making strategic decisions on appeals and follow-ups with insurers.
Insurance Analyst /contract
Pharmacyclics, an AbbVie Company
Remote
05.2024 - 08.2025
- Responsible for contacting speciality pharmacy and obtaining insurance coverage, billing info, prescription prior authorization and or appeals as needed.
- Utilize the appropriate web tools to assess and determine patient eligibility and insurance benefits
- Contact patient to inform them of benefits and estimated out of pocket expense.
- Meet performance standards
- Accurately transmit test claims to verify prescription coverage
- Liaise between healthcare providers, insurance companies, AbbVie Patient Access Support field rep.s
Financial Counselor
Texas Oncology
Austin
03.2023 - 03.2024
- Obtaining referrals and pre-authorizations for treatment
- Obtaining verification of insurance benefits
- Answering questions about account balances
- Locate sources for payment assistance depending on eligibility
- Managing resources as needed for treatments
- Collection on old account balances
- Contacting insurance companies as needed
- Adjusting bad debt on accounts as needed
Medical Billing Specialist
The Center for ENT
Houston
09.2022 - 02.2023
- Responsible for entering patient information into the billing system
- Reviewing and verifying accuracy of patient data and billing information
- Research and resolve discrepancies in patient account
- Process insurance claims and ensure accurate reimbursement
- Answer customer inquiries regarding billing and insurance issues
- Monitor accounts receivable and follow up on unpaid claims
- Maintain up-to-date knowledge of insurance regulations and procedure
- Appeals
- Update insurance policies as they change
- Maintain fee schedules
Medical Billing/Insurance Specialist
Sanova Dermatology
Pflugerville
06.2018 - 09.2022
- Analyzed CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
- Verified patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered by policies when applicable
- Prepared billing statements for patient s and verified correct diagnostic coding.
- Manages workflow of specific area to ensure maximum results for departments as requested by department
- Completes appropriate payor forms related to notification and authorization.
- Calculates accurate patient financial responsibility
- Interprets complex payer coverage information including, but not limited to, network participation status with provider, limited plan coverage and inactive benefits.
- Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Pasted and adjusted payments from insurance companies.
- Identified and resolved patient billing and payment issues.
- Located errors and promptly refilled rejected claims.
- Determined prior authorizations for medication and out-patient procedures.
- Liaised between patients, insurance companies and billing offices.
Pre-Authorization Specialist
Advanced Pain Care
Round Rock
05.2017 - 06.2018
- Educated patients on eligibility and affordability options by offering insight information.
- Contact insurance carries to verify patient's insurance eligibility, benefits, and requirements
- Request, track, and obtain pre-authorization form insurance carriers within the specified time fame allocated for medical and financial services.
- Request, follow up and secure prior=authorizations prior to services being preformed
- Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPPA regulations.
- Communicate any insurance discrepancies or changed among the staff.
- Maintain high level of productivity to ensure overall success of the company
Front Desk Receptionist /Customer Service Rep.
Renaissance Women's Group
Austin
01.2015 - 05.2017
- Helping maintain workplace security by issuing, checking, and collecting badges as necessary and maintaining visitor logs.
- Assisting with a variety of administrative tasks including copying, faxing, taking notes, and making travel plans.
- Hiring, managing, and developing the junior administrative team.
- Provide excellent customer service.
- Scheduling appointments.
- Answering phones in a professional manner, and routing calls as necessary.
- Assisting colleagues with administrative tasks.
Education
General Studies -
Everest Institute
High school diploma - Upper secondary education
Pflugerville High School
Skills
- Communication Skills
- Problem-Solving
- Attention to Detail
- Project Management
- Administrative Support
- Operational Efficiency
- ICD-10 Coding
- Insurance Verification
- Medical Necessity Assessment
- Software Proficiency
Certification
- Certified Dental Assistant
- Series 7
- Driver's License
Willing To Relocate
Austin, TX
Timeline
Pre-Authorization Specialist
Pain Specialists of America
10.2025 - 01.2026
Insurance Analyst /contract
Pharmacyclics, an AbbVie Company
05.2024 - 08.2025
Financial Counselor
Texas Oncology
03.2023 - 03.2024
Medical Billing Specialist
The Center for ENT
09.2022 - 02.2023
Medical Billing/Insurance Specialist
Sanova Dermatology
06.2018 - 09.2022
Pre-Authorization Specialist
Advanced Pain Care
05.2017 - 06.2018
Front Desk Receptionist /Customer Service Rep.
Renaissance Women's Group
01.2015 - 05.2017
General Studies -
Everest Institute
High school diploma - Upper secondary education
Pflugerville High School