Kay Kelley
Ball Ground
Summary
Dynamic and results-driven professional with extensive experience at Medical Associates, excelling in insurance verification and patient referral processes. Proven ability to enhance patient satisfaction through effective communication and problem-solving. Adept at managing high-volume claims while ensuring HIPAA compliance, contributing to improved operational efficiency and timely reimbursements.
Overview
23
23
years of professional experience
Work History
Referral Specialists
Medical Associates
04.2002 - Current
- Called insurance companies to get benefits information on behalf of patients.
- Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
- Streamlined referral processes for increased efficiency, resulting in timely appointments for patients.
- Verified insurance benefits and eligibility before referring clients.
- Promoted clear communication between primary care providers and specialists through detailed documentation and follow-up calls.
- Developed strong relationships with external healthcare facilities, fostering a collaborative approach to patient care coordination.
- Built professional relationships with service providers.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Managed high-volume referral requests by prioritizing tasks and maintaining organized records.
- Enhanced patient satisfaction by promptly addressing inquiries and resolving issues related to referrals.
- Acted as a liaison between referring physicians and specialists, establishing trust and rapport through professionalism.
- Contributed to the development of referral policies and procedures, enhancing departmental operations.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Insurance Claims Specialist
Medical Associates
04.2002 - Current
- Strengthened client relationships by providing clear communication throughout the claims process, ensuring all parties were well-informed of progress and outcomes.
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- Boosted company reputation by delivering exceptional customer service during claim investigations and settlements.
- Contributed to the overall financial stability of the healthcare facility by consistently meeting or exceeding billing and collection targets.
- Monitored outstanding accounts receivable balances for trends that could indicate payer issues or potential collection problems.
- Negotiated payment plans for patients facing financial hardships, minimizing revenue loss while maintaining empathetic customer service.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
- Achieved timely reimbursements for clients through keen understanding of insurance company protocols.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Followed up on denied claims to verify timely patient payment and resolution.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained confidentiality of patient finances, records, and health statuses.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Collected premiums and issued accurate receipts.
- Notified insurance agents and accounting departments of policy cancellations and changes.
Education
High School Diploma -
Cherokee High School
Canton Ga06-1982
Skills
- Insurance verification
- Data entry proficiency
- Medical terminology
- Patient confidentiality
- Appointment reminders
- Medical terminology knowledge
- HIPAA regulations
- Referring physician communication
- HIPAA compliance
- Referral tracking
- Problem-solving
- Patient referral
- Data entry
Timeline
Referral Specialists
Medical Associates
04.2002 - Current
Insurance Claims Specialist
Medical Associates
04.2002 - Current
High School Diploma -
Cherokee High School
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