Summary
Overview
Work History
Education
Skills
Timeline
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Kelly Holland

Georgetown,OH

Summary

Experienced Health Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.

Overview

7
7
years of professional experience

Work History

Core Operations Specialist- Eligibility

Alma
12.2023 - Current
  • Demonstrated exceptional attention to detail in all aspects of medical billing work, resulting in fewer errors and a higher level of accuracy for both internal records and external claims submissions.
  • Participated in ongoing training sessions to stay current on industry best practices for medical billing and coding procedures.
  • Participated in departmental meetings, sharing insights and ideas for improving overall medical billing efficiency and revenue generation.
  • Trained staff on current eligibility requirements and policies.
  • Assessed medical claims for compliance with regulations and corrected discrepancies.
  • Reduced claim processing time by streamlining medical claims adjudication processes.
  • Verified patient insurance coverage and benefits for medical claims.
  • Demonstrated exceptional time management skills, managing competing priorities effectively in order to meet critical deadlines consistently.
  • Reduced claim denial rates by accurately interpreting and applying policy guidelines and benefit coverage limitations.
  • Delivered outstanding results under pressure by maintaining a high level of productivity during challenging periods of increased workload.

Associate Patient Care Coordinator

CenterWell Specialty Pharmacy
02.2022 - 02.2023
  • Assisted with up to 100 calls per shift from providers, insurance companies, and patients.
  • Increased patient satisfaction scores by 40% within 2 Months.
  • Answered patient assistance calls, assessed needs and offered qualified support.
  • Communicated with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures.
  • Maintained confidentiality of patient data and condition to safeguard health information.
  • Conducted literature and coding reviews to adhere to state and federal standards.
  • Resolved billing issues by collaborating with pharmacist, insurance providers and customers.
  • Managed both routine and complex claims situations with same attention to detail and diligence.
  • Verified completeness and accuracy of incoming provider claims. Improved claims handling by incorporating feedback from fraud and abuse department about current trends.

Customer Service Specialist

Arise Virtual Solutions Inc.
07.2017 - 01.2022
  • Kept high average of performance evaluations over 5 years.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
  • Cross-trained and provided back up for customer service managers.
  • Handled over 100 calls per shift signing up new customers, retrieving customer data, presenting relevant product information and cancelling services.
  • Took payment information and other pertinent information such as addresses and phone numbers to place orders.
  • Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
  • Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients’ financial responsibilities.
  • Determined financial needs by assessing existing coverage and aligning new products and services with long-term goals.
  • Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations.
  • Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.

Education

Certificate - Electronic Health Records & Reimbursement

MedCerts
09.2024

Technical Certificate - Business And Finance

Southern Hills Career Technical Center
07.2011

High School Diploma -

Georgetown Jr/Sr High School
06.2011

Skills

  • Customer Relationship Management (CRM)
  • Claims Handling and Coverage Verification
  • Calm and Professional Under Pressure
  • Active Listening
  • Problem-Solving
  • Adaptability
  • Training Development Aptitude
  • Quality Assurance
  • Account management
  • Medical Coding Expertise
  • Healthcare Billing Knowledge
  • ICD-10-CM Understanding
  • Claims Processing Proficiency
  • CPT Code Mastery
  • Insurance Verification
  • Claims Investigation
  • Claims adjustment
  • Billing Software
  • Insurance Coverage Verification
  • Microsoft Office
  • Medical Terminology
  • Medical Billing
  • Insurance Policies Knowledge
  • HIPAA Compliance Understanding

Timeline

Core Operations Specialist- Eligibility

Alma
12.2023 - Current

Associate Patient Care Coordinator

CenterWell Specialty Pharmacy
02.2022 - 02.2023

Customer Service Specialist

Arise Virtual Solutions Inc.
07.2017 - 01.2022

Certificate - Electronic Health Records & Reimbursement

MedCerts

Technical Certificate - Business And Finance

Southern Hills Career Technical Center

High School Diploma -

Georgetown Jr/Sr High School

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Kelly Holland