Kendra Wiley
Sandwich,IL
Summary
Dedicated healthcare professional with 9+ years of experience in medical assisting, medical claims, and prior authorization. Skilled in EHR systems (Epic, Availity), insurance verification, and clinical workflow support. Known for attention to detail, critical thinking, and a passion for improving healthcare through technology.
Talented Prior Authorization Representative with years of implementing strategies to secure authorizations for clinical procedures. Expert delivering continuous clinical quality improvement. Superb influencing skills to communicate with credibility, tact and diplomacy.
Overview
12
12
years of professional experience
2003
2003
years of post-secondary education
Work History
Prior Authorization Specialist
Onco360
Louisville, Kentucky
08.2025 - Current
- Processed prior authorization requests efficiently for various medical services.
- Verified patient eligibility and insurance coverage for treatment procedures.
- Communicated with healthcare providers to obtain necessary documentation.
- Utilized electronic health record systems for tracking authorization status.
Prior Authorization Specialist
Orsini Specialty Pharmacy
12.2022 - 07.2025
- Managed medical claims and prior authorization requests for commercial and government payers (Medicare/Medicaid).
- Leveraged Epic and Availity to process and track claim submissions, improving accuracy and turnaround time.
- Reduced denial rates by proactively resolving issues and submitting complete, payer-compliant documentation.
- Communicated with providers and insurers to verify coverage and expedite approvals, enhancing patient access to care.
- Contributed to workflow optimization initiatives that shortened processing time and improved team productivity.
- Communicated with healthcare providers to obtain necessary documentation.
Medical Assistant
Rush Copley Medical Group
04.2019 - 12.2022
- Assisted with patient triage, documentation, and insurance prior authorization for specialty services.
- Collaborated cross-functionally to streamline referral and billing workflows using EHR systems.
- Contributed to a 15% reduction in billing rejections through accurate data entry and verification.
Medical Assistant
Northwestern Medicine
08.2014 - 04.2019
- Documented patient history, medications, and symptoms; supported physicians during exams and minor procedures.
- Maintained clinical supply inventory and ensured exam rooms met safety and cleanliness standards.
- Delivered high-quality patient service in a fast-paced outpatient setting.
Education
Sandwich High School
Sandwich, ILMedical Assistant Certificate -
Everest College
Skills
- Electronic Health Records (EHR)
- Epic
- Availity
- Cerner
- Insurance Verification
- Medical Claims Processing
- Prior Authorization Management
- ICD-10 Coding
- CPT Familiarity
- Pharmacy Benefit Management (PBM)
- Denial Management
- Appeals
- HIPAA Compliance
- Patient Relations
- Clinical Support
- Critical Thinking
- Problem Solving
- Communication
- Team Collaboration
- Time Management
- Multitasking
- Adaptability in Fast-Paced Environments
- Utilization review experience
- Authorizations
- Precertification requirements
- ICD-10 coding
- Pharmacy benefit management
- Medical appeals handling
- Prior authorization process
- CPT coding
- Insurance verification
Projects
- EHR Process Mapping for Small Clinics, Designed a process improvement plan based on mock EHR workflows in a Coursera course.
- Health Data Dashboard, Building a tool in Excel/Google Sheets to analyze and visualize patient trends for a simulated clinic., In Progress
Continuing Development
- Health Informatics on FHIR, Coursera, In Progress
- Healthcare IT Support Fundamentals, Coursera, In Progress
- Google IT Support Certificate, Coursera, Planned
Timeline
Prior Authorization Specialist
Onco360
08.2025 - Current
Prior Authorization Specialist
Orsini Specialty Pharmacy
12.2022 - 07.2025
Medical Assistant
Rush Copley Medical Group
04.2019 - 12.2022
Medical Assistant
Northwestern Medicine
08.2014 - 04.2019
Sandwich High School
Medical Assistant Certificate -
Everest College