Kelly Harding

***** ****** **. ** ********* C

Albuquerque, N.M. 87111

505-***-****

Email: adwqjl@r.postjobfree.com

OBJECTIVE: Looking for a position as a patient assistant representative in an established organization where I could perform my skills and ability for mutual future growth and profit.

STRENGTHS: Dedicated to providing quality healthcare.

CPR and First Aid Certified.

Communicating well when speaking; effective with both superiors and staff.

Decision making, critical thinking, organizing and planning.

Problem analysis, use of judgment and ability to solve problems efficiently.

Self-motivated and willing to set goals and work to achieve them.

EDUCATION: Central New Mexico Community College, Albuquerque, N.M.

Associates Degree in Integrated Studies, Graduation Date: August 09, 2020

Associates Degree in Nursing, Graduation Date: December 2024 (Anticipated)

RELEVANT EXPERIENCE:

iCare Health Solutions, October 2022-March 2023 Utilization Management Representative

Processed prior authorization requests, following internal policies and procedures.

Adhere to contractual obligations with internal and external stakeholders.

Assured communication of approved outpatient surgical procedures to medical providers and health plan members.

Assisted in directing appropriate requests to in-network providers.

Responsible for forwarding all prior authorization requests to clinicians for medical review.

Maintained appropriate logs, records, and reports as established by Utilization Management Department.

Delegation of work queues to ensure the Utilization Management Department remains in turnaround compliance.

Distinguished between Medicaid and Medicare caseloads and related timeliness.

Communicated with Utilization Management Clinical and Operations Directors to ensure a seamless process amongst the Utilization Management Department.

Adhere to federal HIPPA guidelines and associated corporate policies and procedures.

Presbyterian Healthcare Service, August 2021-August 2022 Patient Access Representative

Provided customer service to PHP members and healthcare community.

Examined and resolved medical claims.

Resolved customer issues, complaints and inquiries/grievances.

Updated member’s demographics/PCP and issued replacement cards with FACETS and Clarity

Responded to incoming calls.

Performed basic financial clearance functions, including insurance verification and authorization.

Acted as a member’s advocate dealing with practitioners, facilities, billing and employer groups.

Knowledgeable with Medicare and Medicaid plans.

UNM Sandoval Regional Medical Center, June 2017-July 2021 Prior Authorization Representative/ER Clerk

Responsible for obtaining prior authorizations in a timely manner.

Updated patient’s demographics and insurances.

Knowledgeable of CPT/ICD-10 codes and medical terminology.

Experienced working with insurance carriers and knowledgeable with insurance plans.

Communicate and interact effectively with physicians, staff, patients, visitors and healthcare community

Verified medical insurances through HDX, New Mexico Medicaid Portal and HealthXNet.

Entered patient admitting orders and information into computer.

Advised, informed and assisted patients before, during, and after their date of service.

Registered patients for ER visits.

Collected copays for ER visits after patients discharged.

Implemented stock control and security procedures and maintained appropriate records.

ADDITIONAL EXPERIENCE:

Alta Mira, Albuquerque, N.M., June 2015-May 2018 Respite Provider

Albuquerque Home Healthcare, Albuquerque, N.M., January 2013-August 2013 Caregiver

Provided support and relief for parents of children with disabilities.

Provided service to the child in a friendly, patient and caring way.

Supervised, maintained a safe and positive environment.

Turned and repositioned bedridden patients, alone or with assistance, to prevent bedsores.

Observed patients’ conditions and reported changes to professional staff.

Measured and recorded food and liquid intake.

Fed patients who were unable to feed themselves.

Assisted patients with walking, exercising, and moving in and out of bed.

Supplied and emptied bed pans applied dressings and supervised exercise routine.

Assisted patients with ADLs.

Transported patients to treatment units, using a wheelchair or stretcher.

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