Keyra Duran
The Bronx,NY
Summary
A dedicated healthcare professional with over 10 years of experience at Columbia University Medical Center, consistently delivering high-quality service and contributing to team success. Now poised to transition into a managerial role, with a focus on enhancing operational efficiency, fostering team collaboration, and driving continuous improvement.
Overview
15
15
years of professional experience
Work History
Senior Billing Coordinator
Columbia University Irving Medical Center (CUIMC)
New York, NY
11.2019 - Current
- Responsible to verify insurance coverage and obtain authorization for procedures performed by the CUIMC Interventional Cardiology & Vascular Therapy (CIVT) and the Structural Heart and Valve programs.
- Lead and Manage a team of Prior Authorization Specialists to ensure productivity and accuracy targets.
- Monitor work queues for CUIMC Cardiothoracic Surgery and Cardiac Catheterization Laboratory to ensure tasks are completed timely and accurately.
- Share Faculty Practice Organization (FPO) Managed Care Bulletin updates with staff and clinical team to ensure seamless transition and efficiency of the revenue cycle process.
- Report payer credentialing and enrollment related issues to PEG Contracting for resolution.
- Responsible for communicating with the clinical team and insurance personnel to overturn a prior authorization denial before the scheduled procedure date.
- Participate in peer-to-peer insurance discussions to understand the appeal process and requirements when a prior authorization denial is upheld.
- Obtain out-of-network insurance prior authorizations and communicate with hospital staff to obtain single case agreement for continuity of care.
- File and submit detailed documentation to the Department of Financial Services for external appeals. Oversee the external review process from inception to completion.
- Work with research team to streamline requirements to improve outcome of prior authorizations that pertain to an investigational medical device in a clinical trial.
- Serve as liaison to assist hospital financial clearance center (NYP FCC) with insurance questions and concerns.
Cardiac Catheterization Laboratory Coordinator
NY Presbyterian Hospital - CUIMC
New York, NY
02.2019 - 11.2019
- Responsible to coordinate outpatient and inpatient procedures in the Adult Cardiac Catheterization Laboratory.
- Collaborate with case managers to ensure procedures are approved by patient health insurance prior to service date.
- Serve as liaison with other departments and physician office staff to arrange for all necessary support services for patient and their procedure.
- Collaborate with clinical team, specialty practice providers and staff to enhance flow of departmental operations.
- Ensure compliance with all Joint Commission standards and quality assurance.
Program Manager
Columbia University Medical Center
New York, NY
11.2015 - 02.2019
- Provide administrative support to the Pulmonary Hypertension Comprehensive Care Center.
- Responsible to coordinate multi-specialty appointments to ensure timely delivery of diagnostic and treatment services.
- Responsible to coordinate same day and elective hospital admissions for both pediatric and adult patients.
- Responsible to obtain insurance prior approval for tests and procedures including out-of-network services.
- Optimize service procedures that improve patient comfort, clinical outcomes and patient satisfaction.
- Serve as liaison to assist patients with insurance concerns. Work with billing team to resolve issue.
- Work with clinical and administrative team to implement strategies to increase program effectiveness and revenue.
- Handle complex academic/clinic calendars and travel planning for team.
Practice Specialist
Weill Cornell Medical College
New York, NY
01.2013 - 10.2015
- Responsible to manage the day-to-day operation for the division of Pediatric Hematology/ Oncology.
- Oversee front end revenue cycle to avoid delays in reimbursement and ensure program's financial success.
- Responsible to interview, train and mentor new staff and ensure appropriate coverage for practice.
- Monitor and track levels of service quality on a daily basis.
- Monitor Key Performance Indicator (KPI) to determine and address performance issues of both physician and practice staff.
- Initiate professional development agenda for administrative / front end staff.
Patient Services Team Lead
Reproductive Medicine Associates Of New York
New York, NY
06.2010 - 12.2012
- Provide administrative support to eleven physicians in five office locations.
- Project management, social media, and marketing outreach for patient referrals.
- Co-supervised team during high-volume patient hours while monitoring high volume inbound patient calls.
- Author of the official training manual used in training all NYC and Mexico office locations.
- Coordinated team building workshops, physician presentations and monthly team meetings to improve patient care, develop employee emotional intelligence and strengthen team morale.
- Train and guide new staff to provide exceptional customer service.
Education
Accelerated Dual Degree Program (Bachelor / Master) - Forensic Psychology
John Jay College of Criminal Justice (CUNY)
2010
Skills
- Analytical and innovative thinker with excellent problem solving skills
- Strong interest in improving workflows to streamline processes for greater efficiency and effectiveness
- Advanced proficiency in health insurance reimbursement policies
- EPIC Healthcare Systems
- Microsoft Office Proficiency
- Bilingual (English / Spanish)
- CUIMC CARE Award Recipient 2022
Timeline
Senior Billing Coordinator
Columbia University Irving Medical Center (CUIMC)
11.2019 - Current
Cardiac Catheterization Laboratory Coordinator
NY Presbyterian Hospital - CUIMC
02.2019 - 11.2019
Program Manager
Columbia University Medical Center
11.2015 - 02.2019
Practice Specialist
Weill Cornell Medical College
01.2013 - 10.2015
Patient Services Team Lead
Reproductive Medicine Associates Of New York
06.2010 - 12.2012
Accelerated Dual Degree Program (Bachelor / Master) - Forensic Psychology
John Jay College of Criminal Justice (CUNY)
Similar Profiles
Ashley MathesonAshley Matheson
Office Administrator at Columbia University Irving Medical CenterOffice Administrator at Columbia University Irving Medical Center
Emily Greeff BSN, RN, PCCNEmily Greeff BSN, RN, PCCN
Registered Nurse at NYP- Columbia University Irving Medical CenterRegistered Nurse at NYP- Columbia University Irving Medical Center
Quinterrel R BattleQuinterrel R Battle
Patient Care Associate - PACU at New York Presbyterian Columbia University Irving Medical CenterPatient Care Associate - PACU at New York Presbyterian Columbia University Irving Medical Center