Kaylah Bennett
Wadesboro
Summary
Experienced healthcare professional with over 9 years of expertise in insurance verification, prior authorization, claims resolution, and customer service. Proficient in Facets, GuidingCare, Epic EMR, Waystar, payer portals, and CRM systems. Skilled in reviewing medical documentation, interpreting ICD-9, ICD-10, CPT, and HCPCS codes, and ensuring compliance with payer guidelines. Demonstrated success in collaborating with providers, payers, and patients to resolve authorization and claims issues while maintaining high levels of customer satisfaction and operational efficiency.
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.
- Utilized Facets to verify member eligibility, benefits, coverage limitations, and claims information for accurate authorization and billing processes.
- Conducted comprehensive insurance verification and benefit investigations using Facets and payer systems to ensure accurate patient coverage information.
Prior Authorization Specialist
Equiliem
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.
- Documented verification findings, authorization statuses, and member information within GuidingCare and other healthcare management systems.
- Navigated GuidingCare to review care management activities, member records, authorizations, and case documentation.
- Utilized medical terminology and coding knowledge (ICD-9, ICD-10, CPT) to accurately process claims and authorization requests.
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 Carolina01.2010
Skills
- Insurance verification
- Proficient in Facets
- Prior authorization processing
- Guiding Care
- 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
Equiliem
01.2019 - 11.2023
Benefits Specialist/Customer Service Representative (Assignment Completed)
Iqor
08.2015 - 01.2019
High School Diploma -
Anson High School