Summary
Overview
Work History
Education
Skills
Communication Skills
Leadership Experience
Personal Information
Accomplishments
Timeline
Generic

Kelly Reilly

Independence

Summary

Experienced EDI and health technology expert dedicated to delivering and supporting quality healthcare. Skilled in overseeing daily operations, managing staff, ensuring compliance with X12 regulations, and providing exceptional customer service. Analyzes real-time connections to ensure seamless flow of customer data to payers and intermediaries.

Overview

17
17
years of professional experience

Work History

Manager of Clearinghouse, EDI/Payers

Evercommerce
06.2024 - Current
  • Team Management: Experience in managing or mentoring a team, as well as resource planning and performance evaluation.
  • Strategic Vision: Understanding how EDI solutions align with the organization's strategic goals, such as improving interoperability, reducing costs, and enhancing patient outcomes.
  • Continuous Improvement: Commitment to continuous process improvement, leveraging new technologies or methodologies for more efficient EDI workflows.
  • Review healthcare electronic data transactions in the form of x12 837, 835, 270/271, 276/277, 278N Ansi files to verify HIPAA compliance.
  • Assist in setting up and maintaining payer connections.
  • Troubleshooting rejections and denials with payers and third-party clearinghouses.
  • Provide EDI training for all new employees in the EDI department.
  • Manual File Transmissions.
  • Assist in transitioning newly acquired companies to fit our process model.
  • Create documentation processes and product utilization.
  • Observe federal and state laws regarding HIPAA maintaining safety of patient information at all times.

EDI Analyst Team Lead and Trainer

Waystar
10.2016 - 05.2024
  • Review healthcare electronic data transactions in the form of x12 837, 835, 270/271, 276/277, 278N Ansi files to verify HIPAA compliance.
  • Assist in setting up and maintaining payer connections.
  • Troubleshooting rejections and denials with payers and third-party clearinghouses.
  • Provide EDI training for all new employees in the EDI department as well as provide tools training for tier 1 staff.
  • Manual File Transmissions.
  • Assist in transitioning newly acquired companies to fit our process model.
  • Create documentation processes and product utilization.
  • Observe federal and state laws regarding HIPAA maintaining safety of patient information at all times.

Customer Quality Specialist

Apria Healthcare
11.2015 - 10.2016
  • Verify Insurance.
  • Maintain patient accounts.
  • Communicate with physicians, referrals, patients, and Insurance carriers.
  • Qualify patients for durable medical equipment through following national standards set by Medicare and Medicaid.
  • Observe federal and state laws regarding HIPAA always maintaining safety of patient information.

Special Populations Director

Johnson County Parks and Recreation
03.2008 - 11.2015
  • Coordinate programming including Special Olympics activities for individuals that live in the Johnson County KS area.
  • Recruit Volunteers.
  • Maintain updated training for these individuals to coach or assist with activities.
  • Develop and oversee the special populations budget, including organization and implementation of fundraisers to subsidize the current budget.
  • Recruit new athletes by speaking at school functions to inform parents and potential athletes of the benefits of Special Olympics involvement.
  • Transport and chaperone athletes on all traveling activities.
  • Supervise staff working at Camp New Horizon's as well as my seasonal assistant.
  • Write a quarterly newsletter to keep parents/athletes/caregivers informed of past, present, and future activities.

Education

Master of Healthcare Administration - undefined

University of Pheonix
01.2016

Therapeutic Recreation Specialist - undefined

Pittsburg State University
01.2003

Skills

  • EDI Health Care x12 Expert
  • Healthcare Industry Knowledge
  • Project Management
  • Communication

Communication Skills

Implemented new procedures and technologies that improved efficiency and streamlined operations.

Leadership Experience

Successfully led a team to optimize internal and external customer support case closures while maintaining excellent customer satisfaction scores.

Personal Information

Title: EDI Manager

Accomplishments

  • Documented and resolved complex real-time eligibility connection issues which led to increased revenue for our providers.
  • Supervised team of four staff members.

Timeline

Manager of Clearinghouse, EDI/Payers

Evercommerce
06.2024 - Current

EDI Analyst Team Lead and Trainer

Waystar
10.2016 - 05.2024

Customer Quality Specialist

Apria Healthcare
11.2015 - 10.2016

Special Populations Director

Johnson County Parks and Recreation
03.2008 - 11.2015

Master of Healthcare Administration - undefined

University of Pheonix

Therapeutic Recreation Specialist - undefined

Pittsburg State University

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Kelly Reilly