Lori Kennedy
Summary
Wishing to utilize my strengths regarding organization with detail management. Skillful Operations Assistant adeptly supporting system management and problem resolution to improve records management. Over 25 years of experience managing customer activity, addressing technical issues and maintaining system operations. Skillfully assessed operational procedures, providing hands-on experience analyzing records and investigating complex troubleshooting issues. Accomplished expert navigating latest compliance regulations and service-level agreements, maintaining strict compliance with updated standards.
Overview
33
33
years of professional experience
Work History
Operations Analyst II
Public Consulting Group
07.2022 - 04.2024
- Managed multiple projects simultaneously, delivering results within tight deadlines while maintaining high-quality standards.
- Improved team productivity by implementing effective workflow strategies and time management techniques.
- Developed and updated tracking spreadsheets using Excel.
- Supported supervisor and associated team members to maintain system functionality.
- Collaborated with cross-functional teams to develop comprehensive project plans, ensuring timely delivery of key milestones.
- Enhanced data accuracy through meticulous attention to detail in data management tasks.
- Optimized operational efficiency by analyzing and streamlining processes.
Pre Cert Analyst
Mays and Schnapp Neurospine and Pain
12.2019 - 07.2022
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Validated results and performed quality assurance to assess accuracy of data.
- Verify Benefits and Pre Cert Requirements for Procedure Ordered
- Entered Benefits into eClinicalWorks System
- 6 Providers/Physicians Assistants Printed Clinical Documentations Based on Procedure Requirements
- 4 Surgery Schedules Managed Pre Cert Vendors for Specific Insurance
- 2 Surgery Locations Submitted Pre Cert Request in Timely Manner
- Maintained Specific Follow-up for Submitted Request
- Scanned Approval into Patient Chart and Entered in Referral Screen.
Insurance Follow-Up Representative
Spectrum Pain Clinic
08.2019 - 11.2019
- Safeguarded patient privacy by adhering to HIPAA guidelines when handling sensitive personal information during claim follow-up processes.
- Investigated and resolved customer inquiries and complaints quickly.
- Insurance Follow-Up - Verifying Insurance Eligibility
- Appealing Claim Denial when Necessary
- Printed all Secondary Medicaid claims that were not 'Rollover' to mail EOB and Claim for Consideration
- Customer Service - Received Patient Calls, Receiving and Posting Payments to Patient Account within eClinicalWorks.
Case Development
Pink Ribbons LLC
07.2018 - 07.2019
- Facilitated smooth internal communications between departments, ensuring all parties were informed of case developments.
- Exceeded patients expectations by providing timely status updates on case developments and promptly addressing inquiries.
- Verify Benefits and Pre Cert Requirements for New DME Cases
- Enter Patient into DMEWorks and PMD Systems
- Requested Clinical Notes based on Case Requirements
- Maintained Working Knowledge of Pre Cert Vendors
- Created CMN, Order and LMN for Submission for Pre-Auth When Required
- Once Approved or Ready to Order Created Sales Order and Purchase Order
- Spoke with Patient Concerning any Deductible or Co-Insurance and Collect
- Write and Maintain Any Payment Plan or Rental Agreement
- Ordered DME Product to be Shipped to Account Rep for Delivery.
Pre Cert Analyst
Comprehensive Pain Specialists
07.2016 - 07.2018
- Verify Benefits and Pre Cert Requirements for Procedure Ordered
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Validated results and performed quality assurance to assess accuracy of data.
- 5 Clinics Entered Benefits into eClinicalWorks System
- 6 Providers Printed Clinical Documentations Based on Procedure Requirements
- 4 Surgery Schedules Managed Pre Cert Vendors for Specific Insurance
- 4 Surgery Locations Submitted Pre Cert Request in Timely Manner
- Maintained Specific Follow-up for Submitted Request
- Scanned Approval into Patient Chart and Entered in Referral Screen.
Provider Relations Representative
Pittman & Associates (HealthSmart Benefits)
08.1991 - 07.2016
- Clerical: Match Checks with Explanation of Benefits for Mailing
- Pulled Claims for Claims Processors from File Room
- Pulled Claims for Specific File (audit claims)
- Refiled Claims by Processor and Process Date
- Posted Mail for Staff
- Billing: Calculated, Printed, and Mailed Bills within the RIMS System on a Monthly Cycle for Select Assigned Blocks of Business
- Posted Monthly Premiums for Select Assigned Blocks of Business
- Eligibility: Maintained Eligibility within the RIMS System Select Assigned Blocks of Business
- Entered Eligibility into Express Scripts for OnLine Drug Program
- Printed ID Cards from RIMS System for Select Assigned Blocks of Business
- Maintained Necessary Underwriting File for Applicants for Select Assigned Blocks of Business
- Provider Relations: Maintained Working Relationship with Network contacts and data base for 156 PPO Networks (linking to assigned fee schedule), network provider updates via Quick Link (PM) (fee schedules, anesthesia rates, special rates discounts, per-diem, or DRG)via appropriate program (PCR, PFS,PCM), downloads of network updates (Micro Soft Word, Excel or Monarch)
- Assisted providers in navigating through various reimbursement processes, resulting in timely payments and reduced financial disputes between parties.
- Strengthened provider networks through regular outreach and relationship building activities.
- Answered provider inquiries via email, telephone and written correspondence.
- Developed comprehensive training materials for new Provider Relations Representatives, facilitating a smooth transition into their roles.
- Working Knowledge of Online Web Based Repricing Systems for Claims
- Filed W-9 Information in System (IRS 1099 Audits)
- Working Knowledge of Claims with Eligibility Questions, working knowledge of plans allowing 'out of area' benefits for ER, Radiology and Anesthesia Services.
Education
Graduated - Computer And Information Sciences
ConCord Career Institute
Memphis, TNGraduated -
Craigmont High School
Memphis, TN05.1980
Skills
- Reporting skills
- Operational Efficiency
- Reporting abilities
- Workflow Optimization
- Process updates
- Operations research
- Microsoft Excel
- Cross-Functional Teamwork
- Business Intelligence
Scrapbooking
I began my love for my paper crafting hobby close to 15 years ago. I taught basic classes at a local Archiver's at night for an odd three years, until the store closed. This soon became my way of relaxing. The sorting through photos and designer paper to design a vivid visual description of an event making anyone viewing wil they had attended.
Timeline
Operations Analyst II
Public Consulting Group
07.2022 - 04.2024
Pre Cert Analyst
Mays and Schnapp Neurospine and Pain
12.2019 - 07.2022
Insurance Follow-Up Representative
Spectrum Pain Clinic
08.2019 - 11.2019
Case Development
Pink Ribbons LLC
07.2018 - 07.2019
Pre Cert Analyst
Comprehensive Pain Specialists
07.2016 - 07.2018
Provider Relations Representative
Pittman & Associates (HealthSmart Benefits)
08.1991 - 07.2016
Graduated - Computer And Information Sciences
ConCord Career Institute
Graduated -
Craigmont High School