Irene Kelly

FRANKLIN, TN.

PHONE 615-***-**** • E-MAIL ac0w6a@r.postjobfree.com

Irene is a highly motivated professional with 11 years of health care experience. Her practical implementation approach to managing client relationships has been a successful formula in creating a better business plan for any organization.

QUALIFICATIONS

ACCOUNT MANAGEMENT SUBJECT MATTER EXPERT CUSTOMER SERVICE

CLAIM APPEALS TRAINING AND DEVELOPMENT HIPAA CERTIFIED

MICROSOFT WORD EXCEL POWER POINT

EXPERIENCE

eviCore Healthcare Franklin TN (Formally MedSolutions) 2004 – 2015

Client Service Manager, 2014 – 2015

Manage overall client relationship:

Meeting operational and technical needs as primary liaison for several high profile accounts.

Identify process improvements and opportunities to better serve our clients.

Implement root cause analysis, monitor and track issues to resolution.

Manage custom project requests in collaboration with cross-functional matrix partners.

Moderating client JOC meetings communicating program performance.

Development of internal client process documentation.

Overseeing Medicare operational compliance in tandem with Accreditation and Delegations unit managers.

Client Service Specialist, (2012 – 2014)

Act as primary liaison between MedSolutions and Health Plan Clients, in order to ensure high quality Customer Service.

Managing several Health Plan operational needs to include high level escalations.

Working with internal Matrix Partner to find root cause resulting in customer satisfaction.

Building trust and close relationship with Health Plan contacts including transparency when identifying internal process and IT issues.

Allocating resources and successfully implementing new programs.

Contributed to the development of business termination documents resulting in smooth transition.

Assisting Sr. Account Managers and Account Executive with capturing necessary information including Internal Health Plan process and reports used in monthly, quarterly joint operational committee meetings.

Monitoring and keeping of client authorization, eligibility and provider file and file layout issues.

Working together with IT technicians ensuring smooth operational functionality.

Working with core team members to provide high performance, quality service and satisfaction.

Assisting with mentoring and training of Client Service representatives.

Claims Appeals Representative, Franklin TN 2011-2012

Reviewed appeal requests related to denied claims.

Documenting all appeals and inputting data for external review.

Re-adjudication of overturn denied claims.

Knowledge of claims processing, claims appeals, inputting accumulator information.

Consistently met or exceeded performance objectives

Health Plan Assistance Representative, Franklin TN 2008-2011

Acting as primary liaison between MedSolutions and Health Plan.

Working closely with Sr. Account Managers managing high level escalations.

Developing good relationships with internal and external customers specifically Health Plan representatives and MSI IT staff.

Monitoring and keeping of client authorization, eligibility and provider file and file layout issues.

Building trust and close relationship with Health Plan contacts including transparency when identifying internal process and IT issues.

Consistently met or exceeded performance objectives

MedSolutions Trainer, Franklin TN 2007

Successfully acting trainer for 2 intake new hire classes consisting of 17 new hire employees including MSI team leads.

Training new hires through training materials, power point, side by side with experienced intake representatives.

Overseeing employee ADP payroll and attendance.

Successfully completing new hire training with score averages of over 97%.

MedSolutions Subject Matter Expert, Franklin TN 2005-2007

First of five recruited as Pilot group for new operations SME position.

Handling calls from existing intake staff in order to assist with higher level escalations.

Policy and procedure training via phone for intake staff.

Teaching intake how to use their tutorial and job aid materials.

First higher level response for provider escalations

Working with internal departments to find root cause and assist in customer satisfaction.

Participating in leadership and team lead training

Consistently met or exceeded performance objectives

MedSolutions Intake representative, Franklin TN 2004-2005

First contact for providers to initiate case

Taking inbound customer service calls

Consistently met or exceeded performance objectives

ADDITIONAL KNOWLEDGE AND EXPERIENCE

Consumer Contact Representative Trans Union, Fullerton CA 1999-2003

●Assisting victims of fraud

●Reviewing fraud damages, inquiries and charges

●Assisting with consumer disputes and crafting fraud alerts to the consumers credit reports

●Working with management in streamlining procedures

●Acted as Ergonomic trainer to include presentations for management and co workers.

Instrument Repair Technician, Gards Music Glendora CA 1997-1999

Overhauling Flutes and Clarinets

Utilizing dangerous chemicals

Operating heavy shop equipment including double industrial size buffing machine and lathe

Re-padding, restructuring, recreating instrument keys.

Re-setting / crafting springs, re-corking joints and keys.

EDUCATION

Alhambra High School, California, 1979

Business and Arts major

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