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
Remote, Ohio
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
Remote, OH
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.
Remote, OH
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