Kelly C. Email & Phone Number

Brentwood, Ny, Us

United States

United States

Ronkonkoma, New York

Analytical Skills • AuditingMedical Billing • Escalation ProcessInfusion Therapy • Subject MatterExperts

Ronkonkoma, New York

Obtain re-authorizations for existing pharmacy and medical benefit patients by submitting required medical documentation, physician’s orders and medical records as required by the payor.Enter authorization information including what services the authorization is for, the case manager (if available) and the expiration date of the authorization into the authorization tracking system.Monitor authorizations pro-actively for renewal using the authorization tracking system though the… Show more Obtain re-authorizations for existing pharmacy and medical benefit patients by submitting required medical documentation, physician’s orders and medical records as required by the payor.Enter authorization information including what services the authorization is for, the case manager (if available) and the expiration date of the authorization into the authorization tracking system.Monitor authorizations pro-actively for renewal using the authorization tracking system though the scheduler and reporting typically working 30 days in advance of authorization expiration.Request medical records from physician offices as required.Perform regular follow-up on re-authorization requests to ensure they have been received and are being processed to avoid delays in scheduled treatments.Troubleshoot any problems during the re-authorization process such as missing information, additional information requests from payors and denied authorizations until requests have been approved or determined to be denied and considered a “No Go”.Perform appeals or assist physician offices with any appeals for denied authorizations.Coordinate with Sales to obtain additional information from physician’s offices needed for re-authorizations or appeals.Perform re-verification of benefits and authorizations to ensure coverage exists for patients being shipped using List H and branch Shipping Lists.Regularly monitor and review existing patient orders in List 3 to verify authorization and benefit coverage for dose and frequency changes and clear them if all requirements are satisfied. Forward orders to Admissions that require a new benefit verification for product change or insurance change. Show less

• Manage reception area, including greeting visitors and responding to telephone and in person requests for information• Maintain front desk and reception area in a neat and organized fashion• Responsible for updating department organizational chart• Make copies, send faxes, organize files, scan documents and handle all incoming and outgoing correspondences• Facilitate working relationships with co-tenants and building management• Cooperate with private insurance providers… Show more • Manage reception area, including greeting visitors and responding to telephone and in person requests for information• Maintain front desk and reception area in a neat and organized fashion• Responsible for updating department organizational chart• Make copies, send faxes, organize files, scan documents and handle all incoming and outgoing correspondences• Facilitate working relationships with co-tenants and building management• Cooperate with private insurance providers to resolve billing issues• Pre pare dental charts, obtain patients medical history and assist dentists during treatments with patients • Use suction devices to keep patients mouth clear and dry and apply bleaching agents and take impressions of patients teeth• Set-up and sterilize instruments and equipment Show less

• Dispersed incoming mail to correct recipients throughout the office• Organized files, developed spreadsheets, faxed reports and scanned documents• Created weekly and monthly reports and presentations• Received and screened a high volume of internal and external communications, including email and mail• Cooperated with Medicaid and private insurance providers to resolve billing issues• Created and maintained spreadsheets using advanced Excel functions and calculations to… Show more • Dispersed incoming mail to correct recipients throughout the office• Organized files, developed spreadsheets, faxed reports and scanned documents• Created weekly and monthly reports and presentations• Received and screened a high volume of internal and external communications, including email and mail• Cooperated with Medicaid and private insurance providers to resolve billing issues• Created and maintained spreadsheets using advanced Excel functions and calculations to develop reports and lists• Produced profit into providers work schedules, accomplished profit goal every week• Greeted and prepared patients for dental examinations• Properly sterilized dental equipment and examination rooms in accordance with infection control policies• Remove sutures and take and develop dental x-rays• Coordinated appointment schedules for both the dentist and oral surgeon• Reviewed status of waiting room on a routine basis to ensure that patients were being seen in a timely fashion• Thoroughly gathered and recorded medical and dental histories and vital signs of patients• Provided appropriate postoperative instructions as prescribed by dentist• Correctly arranged instrument trays prior to dental procedures and surgeries• Made preliminary impressions for study casts and occlusal registrations for mounting study casts• Expertly filed patients' charts and processed billing and payments• Managed invoices and transaction receipts Show less

Master Of Business Administration - Mba, Human Resources Development, 3.6

Bachelor'S Degree, Health/Health Care Administration/Management, 3.6

Associate'S Degree, Liberal Arts And Sciences/Liberal Studies, 3.0

Certificate, Dental Assisting/Assistant

Certificate, Nurse Assistant