Kelsey Moore
Nashville,TN
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over ten years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
11
11
years of professional experience
Work History
Senior Insurance Authorization Specialist
Ensemble Health Partners
06.2021 - Current
- Review scheduled surgeries in Epic to determine active health insurance, eligibility, and coverage.
- Validate CPT and ICD-10 codes for upcoming surgeries, including checking CMS guidelines to determine coverage.
- Review surgical cases and other outpatient/inpatient procedures to determine if prior authorization is required.
- Obtain prior authorization for CMS Medicare and Medicaid, when required, as well as certain vein procedures regardless of insurance coverage.
- Maintain clear, professional, and effective communication with provider offices across seven different hospitals.
- Exceed productivity and quality requirements regarding surgical authorizations within the Epic workqueue.
Project Coordinator
Health Care Service Corporation
07.2018 - 09.2020
- Oversee Quality and Reporting Analysts (QRAs) within the Government Appeals and Grievances and Commercial/Retail departments to ensure timeliness on deliverables due.
- Create, maintain, and monitor QRA spreadsheets regarding Texas Medicaid, New Mexico Medicaid, Medicare, Commercial and Retail product lines, and facilitate tracking of projects and audit deliverables.
- Track and create/maintain documents regarding deliverable timelines, estimate time for task completion, report findings and any expected delays to management.
- Assist department Director with marking-up files for audits, participate in audits, and research concerns that arise during said audit in real-time.
Administrative Assistant II
Health Care Service Corporation
10.2017 - 07.2021
- Data entry and maintenance of corporate and departmental documents.
- Provide general administrative and clerical support such as mailing, copying, faxing, etc.
- Schedule and coordinate meetings, travel arrangements, and interviews/meetings for management.
- Work closely with management regarding 300+ employee payroll functions such as editing punches, inputting time off (PeopleSoft), time off approvals, and inputting requests.
- Assist upper management with administrative duties such as expense reports, organization, staff inquiries regarding corporate policies and procedures, etc.
Customer Advocate II
Health Care Service Corporation
08.2014 - 10.2017
- Respond to and resolve provider inquiries and issues by identifying the assistance needed, such as eligibility, benefits, claims,etc. via telecommunications.
- Research complex issues using multiple programs and applications to resolve provider issues.
- Provide education and status of previously submitted preauthorization or pre-determination requests.
- Consistently exceed performance goals established for position such as efficiency, call quality, first call resolution, attendance and provider satisfaction.
Education
Entry to Nursing -
Columbia University
05.2021
Skills
- Epic
- WorkDay
- Microsoft Office
- Expense Reports
- Claims Processing
- CPT (Current Procedural Terminology)
- SharePoint
- HIPAA compliance
- ICD-10 coding
Timeline
Senior Insurance Authorization Specialist
Ensemble Health Partners
06.2021 - Current
Project Coordinator
Health Care Service Corporation
07.2018 - 09.2020
Administrative Assistant II
Health Care Service Corporation
10.2017 - 07.2021
Customer Advocate II
Health Care Service Corporation
08.2014 - 10.2017
Entry to Nursing -
Columbia University
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