Kathryn Gillam
Fort Irwin
Summary
Experienced Authorization Specialist with a proven track record at Optum, UnitedHealth Group and Seton Medical Center. Strong background in managing authorizations and ensuring compliance. Skilled in navigating complex systems, problem-solving, and maintaining accurate records. Known for effective collaboration, adaptability, and delivering results in fast-paced environments. Reliable team player with expertise in healthcare regulations, communication, and customer service.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Authorization Specialist
Optum, UnitedHealth Group
12.2019 - 02.2024
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
- Developed strong relationships with insurance representatives to expedite approvals and resolve issues promptly.
Authorization Specialist
Seton Medical Center Harker Heights
06.2012 - 07.2015
- Reviewing insurance information, benefits, and coverage requirements to determine eligibility for services.
- Preparing and submitting authorization requests to insurance companies, following up on pending authorizations, and ensuring timely approvals.
- Contacting referring physicians for additional information, answering inquiries from patients and providers, and working with insurance companies to address issues.
- Entering and tracking authorization information, monitoring authorization status, and ensuring accurate billing documentation.
- Ensuring all documentation related to authorization requests is accurate, complete, and up-to-date.
- Responding to patient and provider inquiries, explaining coverage and authorization procedures, and resolving any issues that arise.
- Following established guidelines, protocols, and regulations related to insurance authorization and billing.
Pharmacy Technician
Kaiser Permenente
03.1996 - 05.2004
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Mixed pharmaceutical preparations, according to written prescriptions.
- Clean and help maintain equipment or work areas and sterilize glassware, according to prescribed methods.
- Restock intravenous (IV) supplies and add measured drugs or nutrients to IV solutions under sterile conditions to prepare IV packs for various uses, such as chemotherapy medication.
- Deliver medications or pharmaceutical supplies to patients, nursing stations, or surgery.
Education
No Degree - Pharmacy
Hi-School Pharmacy
Vancouver05-1996
High School Diploma -
Fort Vancouver High School
Vancouver08-1997
Certificate - Medical Transcription
Penn Foster Career School
Scranton, PA05-2015
Certificate - Medical Coding
U.S. Career Institute
Fort Collins, CO11-2024
Skills
- Medical terminology expertise
- Claims management
- Insurance verification
- Data entry proficiency
- HIPAA compliance
- Prior authorization processing
- Documentation and paperwork
- Effective communication skills
- Verbal communication
- Data entry
- Telephone etiquette
- Medicaid
Certification
- Certified Medical Coding Specialist, U.S. Career Institute - November 1st, 2024
- Certified Medical Transcriptionist, Penn Foster - May 1st, 2015
Languages
English
Full Professional
Timeline
Authorization Specialist
Optum, UnitedHealth Group
12.2019 - 02.2024
Authorization Specialist
Seton Medical Center Harker Heights
06.2012 - 07.2015
Pharmacy Technician
Kaiser Permenente
03.1996 - 05.2004
No Degree - Pharmacy
Hi-School Pharmacy
High School Diploma -
Fort Vancouver High School
Certificate - Medical Transcription
Penn Foster Career School
Certificate - Medical Coding
U.S. Career Institute
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