The world of claims is not an easy one to navigate, but fortunately for eSolutions’ clients and staff, Kelly Reilly is there to help guide everyone through the choppy waters.
Kelly is an EDI analyst and Trainer Tier 3 at eSolutions. She provides customer support through analyzing raw data files, troubleshooting payer rejections, training peers in various EDI and clearinghouse tools, and creating training documentation.
EDI, or electronic data interchange, is a system that provides standards to help organizations exchange data electronically. This process occurs behind the scenes, and most people don’t even think about it. Kelly’s job is similar. She takes on many important tasks that support clients and their organizations, as well as eSolutions’ staff, and not many people are aware of it. It’s a big responsibility that Kelly takes seriously.
“Many clients are used to looking a paper claim forms such as UB04 or CMS 1500 claim type forms and really do not know what an electronic claim looks like at all, so it is my job to interpret and quite often translate the information so clients know why their claims are being rejected or denied,” she explained.
Kelly’s life philosophy is to “always be present and accountable,” and she applies this motto daily in doing her job.
“I know that if I come to work and my mind is somewhere else, I am not as effective, so I try to be present every day that I am here,” she said.
Kelly has worked at eSolutions for almost three years. After graduating with her master’s in healthcare administration with an emphasis in healthcare informatics, she took the position with eSolutions because she considered it a great opportunity.
Previously, she ran a Special Olympics team for Johnson County Parks and Recreation for eight years, coordinating team sports, supervising employees/volunteers, and creating/running special fundraising events to support the team. She also worked for Apria Healthcare for a time, verifying eligibility and processing customer orders for DME equipment.
A typical day for Kelly at eSolutions begins with her manually transmitting files each morning. She reviews emails, checks queues and starts pulling tickets to be worked. Another big part of her job is assisting her peers and providers with questions they may have about clearinghouse issues.
Kelly said the most rewarding part of her Client Services position is “being granted the freedom to learn new information that allows me to solve problems, which in turn creates an environment for providers to get their claims processed and paid by payers.”
“Our motto is ‘Strengthen Your Revenue Cycle,’ and we truly are about that business,” she said.
What has been the biggest challenge for Kelly? Learning to speak “EDI lingo” related to the type of files and how they need to be created or processed, she said. “With time and patience, I learned the intricacies of EDI and now am able to train others because of the great training I received,” she explained.
Kelly said she truly enjoys her coworkers and their good sense of camaraderie, which is helpful during stressful days. That positive attitude extends to the team’s work with clients, too.
“Our motto is ‘Strengthen Your Revenue Cycle,’ and we truly are about that business,” Kelly explained. “eSolutions is continuously looking for opportunities to provide valuable insight regarding the cycle of a provider’s claims. We strive to provide excellent client service and develop positive relationships with all of our clients.”
When Kelly is not taking care of clients or helping coworkers, she is happy hanging out with friends and family. She grew up in Overland Park, Kansas, as the middle child in a family of five kids. She loves painting and being outside, especially in the fall when she enjoys firepits and friends. Kelly also is an avid KC sports fan, following the KC Chiefs, KC Royals and KU basketball.
Kelly has amassed many fans herself because of her helpful attitude. She said her best asset as a member of the Client Services team is her capacity to remember things and communicate them to others. “I feel that this is very important, as I am able to recall previous solutions and help my peers resolve issues that I or another coworker may have previously encountered,” she explained.
The fact that she’s from a large family no doubt helps Kelly succeed in her current position. In a family of five, good communication is a survival skill. When it comes to EDI and clearinghouse issues, Kelly’s work family would agree that she’s a great communicator, interpreter and leader for the eSolutions’ Client Services team.