Keyra Vaughn
Sacramento,California
Summary
Friendly, loyal, and dedicated individual with a strong ambition to succeed in any given environment. Extensive experience in the retail sales/customer service industry. Thrives on learning and embraces challenges. Effectively collaborates with others while demonstrating efficiency when working independently. Currently seeking a position to further develop skills, excel, and deliver utmost dedication to an employer.
Overview
15
15
years of professional experience
Work History
Care Authorizations Specialist
TriWest Healthcare Alliance
01.2019 - Current
- Followed all company policies and procedures to deliver quality work.
- Frequently inspected production area to verify proper equipment operation.
- Gathered, organized and input information into digital database.
- Conducted regular reviews of operations and identified areas for improvement.
- Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
- Contacted clients about verifying account information and updated services, answered questions and resolved concerns to uphold exceptional customer service standards and promote brand loyalty.
- Maintained full knowledge of current regulatory environment and made proactive adjustments to meet changing requirements.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
Medical Documentation Representative I
Health Net Federal Services
09.2016 - 12.2018
- Data entry of medical documentation, and all associated tasks that contribute to the data entry process
- Associated tasks include, but are not limited to:
- Data validation and routing
- Inventory control
- Making appointment validation and document reminder calls
- Identifying for Development when requests need further research
- Calling providers when incomplete documentation is received
- Special handling of specialty folders, including but not limited to: Colonoscopy, PET scan, Mammogram
Medical Documentation Representative I
Able Force
03.2016 - 09.2016
- Data entry of medical documentation, and all associated tasks that contribute to the data entry process
- Associated tasks include, but are not limited to:
- Data validation and routing
- Inventory control
- Making appointment validation and document reminder calls
- Identifying for Development when requests need further research
- Calling providers when incomplete documentation is received
- Special handling of specialty folders, including but not limited to: Colonoscopy, PET scan, Mammogram
Caregiver
Home Instead Senior Care
10.2014 - 02.2016
- Giving showers
- Ensuring my client isn't dehydrated overnight
- Toileting
- Keeping an eye out for any redness of the periarea or any other skin tears the resident may receive
- Meal preparation
- Keep families and doctors up to date on residents health or known conditions
- Taking clients to and from all appointments
- Going grocery shopping and helping with all daily life tasks
Caregiver/ Med Tech
Gramercy Court
03.2014 - 10.2014
- Distribute narcotics as prescribed by doctors and also daily medication ensuring that the resident is receiving the correct dosage and at the right time
- Giving showers
- Ensuring my resident isn't dehydrated overnight
- Toileting
- Keeping an eye out for any redness of the periarea or any other skin tears the resident may receive
- Meal preparation keep families and doctors up to date on residents health or known conditions
Back up supervisor/ cashier
DDs Discount
04.2010 - 07.2014
- Reconcile my register
- Complete customer transactions
- Make sure to create a safe environment for customers and make sure store sales are being met
- Count all funds in safe
- Order all change and cash needed for next business
- Calculate and find all cash shortages
- Count and deposit all funds to bank for Garda to pick up
seasonal clerk
Franchise Tax Board
03.2011 - 04.2014
- Company Overview: Franchise tax board, 3646 Butterfield Ave
- With the state I preprocessed tax forms, scanned checks to banks and filing
- Franchise tax board, 3646 Butterfield Ave
Medical Assistant
Sacramento Occupational Medical Group
01.2010 - 03.2010
- As a medical assistant I ran the front desk, scheduled patient appointments, gave injections, medical Billing and coding and patient referrals
Education
Medical Assistant -
High Tech institute
Rancho Cordova, CA03.2010
Skills
- Customer support
- Goal-oriented mindset
- Customer relations
- Data entry proficiency
- Client services
- Records management
- Telephone reception
- Performance improvement
Professionalsummary - Personalstatement
I am a friendly, loyal and clearly dedicated individual who has an ambition to succeed in any given environment. Although I have extensive experience in the retail sales/ customer service industry, I love to learn, and am always up to a challenge whatever the situation. I get along well with others, whilst also working efficiently on my own. I am seeking a position where I can develop and excel while giving my best to an employer.
Timeline
Care Authorizations Specialist
TriWest Healthcare Alliance
01.2019 - Current
Medical Documentation Representative I
Health Net Federal Services
09.2016 - 12.2018
Medical Documentation Representative I
Able Force
03.2016 - 09.2016
Caregiver
Home Instead Senior Care
10.2014 - 02.2016
Caregiver/ Med Tech
Gramercy Court
03.2014 - 10.2014
seasonal clerk
Franchise Tax Board
03.2011 - 04.2014
Back up supervisor/ cashier
DDs Discount
04.2010 - 07.2014
Medical Assistant
Sacramento Occupational Medical Group
01.2010 - 03.2010
Medical Assistant -
High Tech institute
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