Kathy Miles
Marion
Summary
Dedicated and compassionate Healthcare Navigator with over 10 years of experience in patient advocacy, healthcare benefits coordination, and insurance verification. Proven ability to connect underserved individuals and families with critical resources, navigate complex healthcare systems and collaborate with cross-functional teams. Recognized for excellence in patient care, community outreach and emergency intervention. Strong organizational skills, cultural competence and a passion for improving health equity.
Overview
10
10
years of professional experience
Work History
Insurance Verification Specialist
SCA Surgery
08.2020 - Current
- Verified insurance eligibility and benefits for patient procedures, ensuring accurate information for billing purposes.
- Coordinated with healthcare providers to gather required documentation for pre-authorization processes.
- Utilized electronic health record systems to streamline data entry and track patient insurance status.
- Communicated effectively with patients regarding insurance coverage, reducing confusion and enhancing satisfaction.
- Analyzed discrepancies in insurance claims, collaborating with billing department to resolve issues promptly.
- Educated team members on updates in insurance policies and procedures to maintain compliance and efficiency.
- Implemented process improvements that increased accuracy of verification results by standardizing workflows.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
- Assisted patients with understanding personalized insurance coverage and benefits.
Healthcare Navigator
BayCare Health System Inc.
10.2017 - 08.2020
- Coordinated patient navigation processes to ensure seamless access to healthcare services.
- Developed and implemented strategies to improve patient engagement and satisfaction metrics.
- Collaborated with multidisciplinary teams to address barriers to care for diverse patient populations.
- Educated patients on available resources, treatment options, and community support services.
- Led training sessions on new systems for tracking patient referrals and appointments effectively.
- Exercised strong decision-making skills during high-stress emergency scenarios while adhering to company policies and procedures.
- Reinforced culture of continuous improvement by regularly reviewing and updating navigation procedures.
Healthcare Navigator
ClaimAid
09.2015 - 10.2017
- Analyzed patient feedback data to identify trends and recommend service improvements.
- Mentored junior navigators in effective communication techniques and best practices for case management.
- Outstanding ability to communicate with patient-specific Health-coverage navigation.
- Maintained Productivity standards as measured by monthly productivity reports and average monthly accounts per day.
- Streamlined communication between bridge team members, fostering a collaborative working environment for successful navigation.
Education
No Degree - Business Management
University of Phoenix
Marion, Indiana06-2028
Skills
- Health Coverage Navigation (Medicaid, Medicare, Commercial, Marketplace)
- Insurance Verification & Prior Authorization
- Patient Advocacy & Community Resource Coordination
- Cerner, Availity, Zirmed, Excel, EMR Systems
- HIPAA Compliance & Confidentiality
- Crisis Intervention & Emergency Support
- Team Collaboration & Effective Communication
Teammate of the Quarter 2025 and Teammate of the Year 2023 at SCA Health
I have been nominated by my peers as a Value Hero two years in a row. Collaborated with management and other professionals in getting three new centers brought on board. During this time communicating with professionals as high as CEO and Management to the patients we serve to make sure there is a smooth transition. I was nominated for Teammate of the Year in 2023 for the success of bringing on another facility for IU. I then was nominated this year for Teammate of the Quarter for bringing on two facilities for Kentucky.
Timeline
Insurance Verification Specialist
SCA Surgery
08.2020 - Current
Healthcare Navigator
BayCare Health System Inc.
10.2017 - 08.2020
Healthcare Navigator
ClaimAid
09.2015 - 10.2017
No Degree - Business Management
University of Phoenix
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