Medical Sales

Patricia L. Kelly

*** ****** ***** **. **** Zurich, IL 60047

Home 847-***-**** Cell 847-***-****

Email *********@*********.***

Work Experience

Rush Prudential Health Plans 1994 - 1997

Referral Coordinator, Utilization Management

. Responsible for processing inbound physician office calls to determine

if requested procedure met medical necessity criteria.

. Responsible for eligibility verification and knowledge of covered

benefits of managed care plans HMO, POS and PPO

. Coordinated the entry of referrals for DME, diagnostic procedures,

outpatient surgical procedures and 24 hr. observation in to the

clinical system.

. Knowledge of ICD-9 and CPT coding terminology for referral

authorizations

. Mentored new employees

Chicago HMO 1993 - 1994

Claims Processor, Claims Department

. Responsible for processing payment of medical claims for outpatient

services.

. Achieved the targeted volume of processed claims daily.

. Responsible for eligibility verification, in network determination and

CPT coding.

MetLife Network of Illinois 1990 - 1993

Member Services Representative

. Responsible for answering inbound calls from plan members, employer

benefits managers and medical providers regarding eligibility and

benefit plan coverage questions, resolution of claims inquiries and

provider network issues. Ability to work independently

. Processed physician office claims

. Mentored new employees

Evanston Hospital 1989 - 1990

Patient Registration Coordinator - Temp Position

. Greeted patient upon arrival to the hospital, entered patient's

personal and insurance information in to the admission registration

system.

. Responsible for insurance verification, collection of completed forms

and provided direction on the next steps following registration.

Buffalo Grove Park District 1988 -1989

Program Coordinator

. Responsible for hiring staff to lead various programs as well as

contracting with outside vendors to deliver services for programs.

. Assisted park district pre-school program by supporting teachers with

classroom activities such as arts and crafts, physical education

classes, holiday parties

. Accountable for a department budget and development of program

descriptions, scheduling and coordination with other departments at

the park district

Northbrook Park District 1986 - 1988

Registration Coordinator

. Responsible for registering individuals for park district classes

. Front desk operations including answering incoming calls, data entry

and collecting fees

Education

Bachelor of Arts, Parks & Recreation Administration Minor in

Health

Northeastern Illinois University

Community

Volunteer at the St. Francis De Sales Food Pantry, Lake Zurich, IL

References Available Upon Request

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