Priscilla Keys
Broadview
Summary
Healthcare administrative professional with 20 years of experience supporting utilization management, authorization workflows, and high-volume clinical operations. Skilled in EHR documentation, payer communication, insurance verification, and HIPAA-compliant processes.
Overview
2026
2026
years of professional experience
Work History
Sales Associate (Flex)
Macy’s
01.2018 - Current
- Delivered consistent, high-quality customer service in a fast-paced environment while managing competing priorities.
- Maintained professionalism and accuracy during high-volume customer interactions.
- Demonstrated adaptability by supporting multiple departments as needed.
- Contributed to positive customer experiences and repeat business.
Referral Specialist Manager I
Carelon Medical Benefits Management
2022 - 2024
- Oversaw administrative and operational workflows within a complex, multi-system healthcare call center supporting utilization management and authorization processes.
- Managed escalated clinical and authorization-related inquiries, ensuring accurate EHR documentation, timely resolution, and compliance with HIPAA standards.
- Communicated authorization outcomes, clinical needs, and operational updates to leadership and cross-functional teams.
- Generated and analyzed performance reports using Excel and internal databases while coaching staff on documentation accuracy and process compliance.
Referral Specialist Team Lead
Carelon Medical Benefits Management
01.2016 - 01.2022
- Managed high-volume inbound and outbound communications (phone, fax, email, provider portals) related to clinical referrals and authorizations.
- Verified insurance information, supported submission of clinical documentation to payers, and accurately documented actions in EHR and tracking systems.
- Served as subject matter expert across multiple clinical programs while supporting provider portal navigation and troubleshooting.
- Identified authorization delays, documentation gaps, and workflow issues; escalated appropriately and provided process improvement recommendations.
Referral Specialist I & II
Carelon Medical Benefits Management
01.2007 - 01.2015
- Processed and documented clinical referral and authorization requests in high-volume healthcare environments.
- Coordinated with internal clinical teams to ensure timely follow-up on authorization decisions and documentation requirements.
- Delivered professional, courteous customer service to providers, payers, and internal stakeholders.
- Managed the portfolios of several major clients with over $8.5M in total assets.
Education
Associate of Arts - Business
City Colleges of Chicago-Wilbur Wright College
Chicago, ILSkills
- Utilization Management Support; Authorization & Referral Processing; EHR Documentation; Insurance Verification; Payer Communication
- HIPAA & Confidentiality Compliance; Physician & Provider Support; High-Volume Administrative Operations
- Microsoft Outlook, Word, Excel (Advanced), PowerPoint; Spreadsheet Tracking & Reporting
- Provider Portals & Electronic Systems; Data Entry & Analysis; Typing Speed: 55 WPM
Accomplishments
- Implemented standardized onboarding and side-by-side checklists to improve new hire training and documentation accuracy.
- Coached and developed team members resulting in multiple promotions to Referral Specialist II, III, Team Lead, and Manager roles.
- Contributed to New Clinical Engine (NCE) implementation by identifying intake issues, validating frequency and severity, and improving system guidance for staff.
- Led outreach initiative that increased provider portal usage by 40% within four months
Timeline
Sales Associate (Flex)
Macy’s
01.2018 - Current
Referral Specialist Team Lead
Carelon Medical Benefits Management
01.2016 - 01.2022
Referral Specialist I & II
Carelon Medical Benefits Management
01.2007 - 01.2015
Referral Specialist Manager I
Carelon Medical Benefits Management
2022 - 2024
Associate of Arts - Business
City Colleges of Chicago-Wilbur Wright College