Kaylah Bennett
Wadesboro
Summary
Experienced healthcare professional with over 9 years of expertise in prior authorization, insurance verification, and customer service across leading organizations. Skilled in reviewing medical documentation, interpreting ICD-9, ICD-10, CPT, and HCPCS codes, and ensuring compliance with payer guidelines for authorizations, claims, and appeals. Proficient in managing denials and grievances, coordinating with providers, payers, and patients to achieve timely resolutions. Adept at utilizing Epic, Waystar, payer portals, CRM tools, and Microsoft Excel to track requests, analyze trends, and generate reports that support operational efficiency. Recognized for delivering exceptional customer service by explaining benefits, resolving discrepancies, and assisting patients with insurance policies and out-of-pocket costs.
Overview
11
11
years of professional experience
Work History
Insurance Verification Specialist
Guidehouse
11.2023 - 04.2026
- Applied knowledge of medical terminology and payer requirements to ensure accurate claim submissions on UB-04 and CMS-1500 forms.
- Conducted insurance verifications to ensure accurate patient coverage information.
- Utilized electronic health record systems to document and manage verification processes.
Prior Authorization Specialist
Cigna
01.2019 - 11.2023
- Processed and reviewed prior authorization requests for medical procedures, medications, and services, ensuring compliance with payer guidelines and medical necessity requirements.
- Verified and validated patient insurance coverage, benefits, and co-pays across multiple systems to prevent delays in treatment and billing.
- Handled 30-50 inbound and outbound calls daily, addressing patient and provider inquiries regarding coverage, prior authorizations, and claim status.
- Utilized medical terminology and coding knowledge (ICD-9, ICD-10, CPT) to accurately process claims and authorization requests.
- Communicated with healthcare providers to clarify patient information and requirements.
Benefits Specialist/Customer Service Representative (Assignment Completed)
Iqor
08.2015 - 01.2019
- Assisted employees and customers with benefit-related inquiries, including health, dental, vision, and retirement plans, by providing clear explanations and resolving issues in a timely manner.
- Processed benefit enrollments, changes, and terminations, ensuring accuracy and compliance with company policies and regulatory guidelines.
- Educated employees on eligibility requirements, coverage options, and enrollment deadlines to support informed decision-making.
- Coordinated with insurance providers to resolve claims and inquiries.
Education
High School Diploma -
Anson High School
Wadesboro, North CarolinaSkills
- Insurance verification
- Prior authorization processing
- Claims resolution
- Denial management
- Appeals handling
- Eligibility and benefits verification
- Medical billing support
- ICD-9, ICD-10, CPT, HCPCS coding
- Medical terminology
- UB-04 and CMS-1500 forms
- Epic EMR
- Payer portals navigation
- Waystar system
- CRM tools
- Microsoft Excel
- Microsoft Word
- Report generation
- Data analysis
- Trend tracking
- Customer service
- Call handling (inbound and outbound)
- Provider and payer communication
- Patient education on Benefits and Enrolments
Timeline
Insurance Verification Specialist
Guidehouse
11.2023 - 04.2026
Prior Authorization Specialist
Cigna
01.2019 - 11.2023
Benefits Specialist/Customer Service Representative (Assignment Completed)
Iqor
08.2015 - 01.2019
High School Diploma -
Anson High School