Leah C. Kelly
Austin,Texas
Summary
Efficient Benefits and Authorization Specialist with comprehensive knowledge of medical insurance policies, and procedures. Demonstrated ability to liaise effectively between patients, healthcare providers, and insurance companies for smooth transactions. Strengths include strong problem-solving skills, thoroughness in documentation and a keen eye for identifying inconsistencies.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Benefits and Authorization Specialist
Revenue Cycle, UTHealth Austin
Austin, TX
10.2024 - Current
- Responsible for the accurate and timely confirmation of insurance benefits eligibility for patient encounters, and documenting information clearly in the EHR.
- Responsible for the accurate and timely obtainment of prior authorizations for procedures, surgeries, imaging, and other services.
- Reviewed authorization requests for accuracy and completeness.
- Accurately calculates patient financial responsibility for services and works with the Concierge Team and others to enable timely collections.
- Meets or exceeds established performance targets, established by the Clinical Revenue Cycle Director.
- Performs root cause analyses and identifies trends timely to minimize lag days and maximize opportunities to improve the process and update the Electronic Health Record logic as needed.
- Demonstrates good judgment in escalating identified root causes and trends to leadership to ensure timely resolution and communication to stakeholders.
- Communicates effectively with Access and Outcomes Centers, health access partners, regarding patient scheduling and related issues.
- Communicates effectively with the Billing and Coding team on insurance and authorization-related issues.
- Provides customer service to patients by educating them on insurance coverages and authorized services.
- Maintains working day-to-day knowledge of the EHR.
- Other duties and special projects as assigned, related to insurance and authorizations.
Surgery scheduler, MA, front office receptionist, Medical Records
All Star Orthopedics of Austin
03.2013 - Current
- Communicates effectively and appropriately with patients, families, and staff
- Ensure proper allocation of new patient referrals through appointment line and/or incoming faxes
- Covers job functions as needed when staff is absent or during high volumes
- Registers and schedules new patients with physician, schedules follow up, preoperative exams and post operative exams
- Rescheduled appointments if needed
- Answer phone calls through out the day
- Sort and route incoming faxes
- Surgery scheduling- Demonstrates in understanding medical terminology
- Procedures and diagnosis necessary to perform appropriate scheduling
- Schedules surgeries at appropriate facilities based on patient's insurance, verifying times with patients, schedule surgical assistants and schedule surgical representative for each surgery
- Obtains insurance authorization and collect patient's financial responsibility
- Knowledgeable in coding, able to look up codes specific to diagnosis and scheduled procedures
- Initial MRI authorizations for different imaging facilities
- Medical Records- Obtains documentation requested by the healthcare professionals, Maintain and protect sensitive and private information by keeping patients records confidential in accordance with hospitals , HIPAA, federal laws and regulations
- Faxing operative reports to hospital and billing offices
- Import operative reports into patient's charts and faxing operative notes to designated hospitals
- Medical Assistant- Verify patient information by interviewing patient, recording medical history and confirming visit
- Perform preliminary physical test; weight, temperature
- Counsels patients by transmitting physician orders and questions regarding surgeries
- Complete records by recording patient examination, treatment and test results
- Removal of any staples, stitches or debridements from patients surgical incision post operative exams
- Assist physician with any in office procedures (injections, wound care)
- Sterilize surgical instruments in a Autoclave (hemastats, scissors, staple remover, tweezers)
- Order medical supplies and stock patient rooms
- Preauthorization viscosupplementation injections with insurance companies
- Fit patients for any DME products
Customer Service/ Sales Associate
Super Target
Austin, Tx
11.2010 - 01.2011
- Greet customers and ascertain what each customer wants or needs
- Describe merchandise and explain use, operation, and care of merchandise to customers
- Answer questions regarding the store and its merchandise
- Place special orders or call other stores to find desired items
Education
Medical Billing and Coding Program -
Southern Careers Institute
Austin, TX07.2012
Skills
- Data entry proficiency
- HIPAA Compliance
- Prior authorization processing
- Insurance Verification
- Effective communication skills
- Medical terminology expertise
- Telephone Etiquette
- Eligibility procedures
- Proficient use of computers and a working knowledge of Microsoft Office
- Ability to function in a fast-paced environment
- Ability to be flexible with assignments and multitask as needed
- Ability to demonstrate problem-solving skills in dealing with insurance and authorization issues
Certification
- Non-Certified Radiological Technician - 01/25/2023 to current
Timeline
Benefits and Authorization Specialist
Revenue Cycle, UTHealth Austin
10.2024 - Current
Surgery scheduler, MA, front office receptionist, Medical Records
All Star Orthopedics of Austin
03.2013 - Current
Customer Service/ Sales Associate
Super Target
11.2010 - 01.2011
Medical Billing and Coding Program -
Southern Careers Institute
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