Administrative Assistant, Prior authorization, and Member services pos

Kasey Vaughn

Self motivated, punctual, and reliable.

Lubbock, TX 79410 +1-806-***-**** ********************@***********.*** Professional Summary

Efficient and detail-oriented Member Support Specialist with 12 years of experience in healthcare and customer service in general. Proven expertise in verifying patient eligibility, managing accounts, and maintaining HIPAA compliance. Demonstrated ability to collaborate effectively with healthcare providers and members all while achieving key performance indicators. Skilled in utilizing electronic health records and CRM software to enhance operational efficiency and ensure high-quality patient care. Seeking to apply my extensive experience in a senior remote or hybrid CSR position. Work Experience

Pre-Authorization Specialist-remote

Wipro-UHG Lubbock, TX

September 2023 to February 2025

• Verified patient eligibility and benefits coverage to determine pre-authorization

• Managed a high volume of inbound/ outbound calls as well as emails from patients, healthcare providers, and insurance representatives

• Maintained accurate records of all prior authorization activities in electronic health record systems

• Adhered to HIPAA regulations

• Utilized knowledge of medical terminology, CPT codes, ICD-10 codes, and HCPCS codes

• Maintained a high level of professionalism and customer service

• Demonstrated attention to detail.

CSR - Customer Service Representative

ROI Call Center Solutions/Connexus Resource Group UT January 2021 to April 2023

• Receive inbound calls regarding OTC/HBP benefits.

• Provide balance, place orders, as well as tech support for mobile app and website downloads/registration.

• Desquialte complaints and resolve issues in a timely and professional manner

• Utilize CRM software to track customer interactions, update account information, and document issue resolutions

• Achieve monthly targets for average handle time (AHT) while maintaining quality standards for each interaction with customers

Professional Development

COVID-19 Lubbock, TX

March 2020 to January 2021

• Due to the Covid-19 pandemic conducted research to identify emerging trends for new remote business practices..

• Developed comprehensive plans aligned with objectives for new employement.

• Identified opportunities for self improvement for job retention.

• Prepared for and pursued remote opportunities

In Home Caregiver

Calvert Home Health and Hospice Lubbock, TX

January 2018 to January 2020

• Assist clients with activities including bathing, dressing, grooming, and mobility support while providing companionship

• Managed clients' medical appointments and coordinated transportation

• Assist clients with therapeutic exercises and rehabilitation activities, supporting physical health/recovery goals CSR - Customer Service Representative

Wholesale Payments Lubbock, TX

November 2016 to January 2018

• Built strong relationships with key decision-makers leading to a increase in appointment conversions

• Researched target industries and companies for appointment setting campaigns

• Consistently achieved a call-to-appointment conversion rate above company average Caregiver (Full-Time)

Home Instead Senior Care Lubbock, TX

March 2014 to November 2016

• Provide compassionate care and support to clients, ensuring their safety, comfort, and well-being

• Assist with daily activities such as bathing, dressing, grooming, and medication management along with appointment and transportation arrangements

Customer Service Representative

Telephone Marketing Services Lubbock, TX

April 2011 to March 2014

• Outbound calling appointment setter for insurance agents. Providing leads for agents to follow up with potential customers.

• Communicated insurance coverage options, terms, and conditions to clients

• Managed a high volume of incoming calls from policyholders regarding claims, billing inquiries, and policy changes

• Maintained a high level of professionalism during difficult customer interactions Class B CDL Driver

Citibus Lubbock, TX

August 2007 to April 2011

• Maintenance upkeep on fleet for Citi bus transportation

• Data entry and record keeping of paperwork/ invoices/ billing associated with such repairs for entire fleet.

• Collaborated with other drivers and transportation staff to coordinate schedules

• Maintained parts inventory

Self Employed Owner/Operator

DBA: Developing Dreams Daycare, Dreamland Sparkle, Dreamy Casseroles, also Cheap As You Can Dream

Lubbock, TX

January 1999 to August 2007

• Cared for infants to school aged children

• house or office cleaning business

• yummy casseroles to go... hot and ready or frozen to cook at home

• buying/selling storage unit contents!

In-home daycare that was registered with the City of Lubbock, Tx Cleaned houses and businesses

Cooked casseroles hot and ready or frozen take home and heat. Storage auctions, purchase units through winning bids, then selling of contents from units. Education

Phone and CSR etiquette (Online)

Online Remote

September 2023 to February 2026

High school or equivalent

Lubbock High School Lubbock, TX

August 1996 to January 1999

Skills

IVR Maintaining patient confidentiality Paycom Healthcare compliance Multi-line phone systems

- Multi-line phone system experience (11-15 years) ICD-10 Medical terminology Managing teams in a customer support role - Largest customer support team managed (6-10 team members) Insurance verification Windows Salesforce Medicare CRM software Clinical documentation Cxone Genesys Centers for Medicare and Medicaid Services (CMS) NICE CPT coding Microsoft Office, Word, Excel and Quickbooks many other computer programs. Okta Managing client accounts - Client account management (3-5 years) Telephone operations experience within corporate sector Organizational skills Customer complaint resolution VPN ADP HIPAA Attention to detail litmos ICD-9 VoIP Five9 Medical billing Health insurance authorizations Technical Proficiency

Languages

English - Fluent

Certifications and Licenses

CDL Class B

November 2011 to March 2019

Additional Information

Authorized to work in the US for any employer

Contact this candidate