Resume

Customer Service Manager

Location:

Ballwin, MO

Posted:

July 26, 2015

Contact this candidate

Resume:

Kimberly E. McKelly

**** ****** ******* #* **., Chesterfield, MO 63017

314-***-**** or E-mail: acqxqr@r.postjobfree.com

Professional Summary

Focused, meticulous and broadly skilled professional with a 14 year background and a wealth of knowledge in medical billing, claims and office administration. Extraordinary eye for detail and a strong customer service ethic. Adept at working independently or as part of a team. Able to handle high volumes of paperwork and data quickly and accurately.

Core qualifications:

Very detail oriented

Creative problem solver

Highly motivated

Disciplined

Skilled multitasker

Strategic thinker

Collaborative and respectful

Goal oriented

Ability to adapt to new situations

Quick learner with the desire for continuous personal growth

Reliable, hard working and dedicated team player who works well under pressure

Excellent communication and interpersonal skills

Great time-management

Computer literate

Personal Awards:

Outstanding Service Recognition Award (3 time recipient)

Perfect Attendance Award (5 years)

Employee of the Month

Experience:

Jan 2015 - May 2015 Magellan Health Services, St Louis, Missouri

Claims Processing/Claims Resolution

Validated information and processed claims on all medical claims from providers seeking payment (Processed higher level of care claims at 97% accuracy)

Oct 2013 - Nov 2014 Benchmark, St Louis, Missouri

Oct 2011 - Oct 2013 Reimbursement Solutions, St Louis, Missouri

May 2010 - Oct 2011 Microsystems, St Louis, Missouri

Sept 2009 - May 2010 Freelance, St Louis, Missouri

May 2002 - August 2009 Medtech, St Louis, Missouri

Medical Biller/Account Manager

Performed outpatient medical billing for multiple offices/facilities with the specialties of:

oGeneral Surgery

oPediatrics

oPsych

oNephrology

oOb/Gyn

oNeurology

oInternal Medicine

oPain Management

oOphthalmology

oDermatology

Chiropractic

Account Manager for 7. Responsible for aging on all offices.

Billed services for Medicare, all health plans, Texas, Virginia and Illinois Medicaid

Familiar with EDI processes and procedures (Used Relay Health and Gateway)

Responsible for entering charges and payments

Managed denials and aging

A/R research for processed claims:

oResearched reason for non payment

oApplied corrections where applicable

oRebilled as necessary

oCreated appeals

oFollowed up on claims appeals

Managed A/R report and tracked provider services reporting

Assisted physicians in obtaining preferred provider status with insurance companies (BCBS, UCH, Aetna, HealthLink, TriCare, WellCare, Etc)

Worked with management to determine flow of collections – sent to an agency/attorney, written off or left on the books

Continued communications with office staff, physicians and support staff

Worked with IT team to an efficient tracking and follow up system saving time and office resources

Used strong working knowledge and use of appropriate CPT codes, modifiers and ICD9 codes (system would automatically convert to ICD 10 codes) to code records by following prescribed coding standards

Reviewed physician notes to obtain necessary clarifications where necessary

Assigned appropriate medical codes to all diagnosis and services

Prepared appropriate claims documents

Followed up with insurance companies and ensured all claims came to fruition

Accurately applied payments to patient accounts

Posted and reconciled insurance and patient payments.

Researched and resolved incorrect payments, EOB rejections and other issues with outstanding accounts

Retrieved Electronic Remittance Advice (ERA’s)

Sent secondary claims upon processing of primary insurance

Knowledge in timely filing restrictions

Insured office practices were in compliance with HIPAA regulations

Analyzed billing to improve coding data accuracy for Medicare compliance reimbursement

Ensured coded data accurately reflects service provided, based on documentation, guarding against fraud and abuse

Assigned codes on all diagnoses, procedures, professional service, and supplies with the most accurate and descriptive ICD-9-CM, CPT-4, Evaluation and Management and HCPCS codes for all patient encounters for reimbursement

Bill insurance claims automated or manual using HCFA 1500

Verify insurance eligibility, follow-up on all insurance denials

Audit claims for accuracy, completeness.

Submit reimbursement claims to insurance companies and government entities

Collect patient payments and maintain billing records

Monitored accounts for discrepancies in coding, pricing and office errors

Required at least 300 charges per day and for aging 30-40 per day

Jan 1995 - May 2002 MedPlus, St Louis, Missouri

Office Manager

Supervised administrative staff in a clinic of three medical doctors, five chiropractors, two physical therapists, 3 physical therapy assistants and support staff (24 employees) including front desk, patient billing and claims staff

Assured impeccable customer service

Wrote policies and procedures of the clinic to maximize patient flow and customer service

Assured all patient files were maintained

Prioritized patient flow for a 13 professional clinic

Hired, oriented and trained new staff

Conducted performance evaluations

Conducted monthly team meetings with staff and weekly one-on-one meetings with individual staff members

Implemented best practices

Directed/prioritized work activities of team

Provided staff development and disciplinary action as needed

Managed payroll, accounts payable and accounts receivable, made bank deposits

Managed office operations to ensure efficient office environment

Managed supply orders and maintained relationships with vendors and suppliers

Assisted with advertising mailers and promotions including review of content with the marketing team

Supervised credentialing of all licensed staff to achieve and maintain preferred provider status with insurance companies. (BC/BS, UHC, Aetna, HealthLink, TriCare, etc.)

Managed daily, weekly, monthly office reports to track patient numbers, visits, staffing, claims aging, etc and responded with the appropriate departments accordingly

1989 - Jan 1995 First Bank

Teller Supervisor

Supervised 12 tellers

Hired, oriented and trained new staff

Conducted performance evaluations

Conducted monthly team meetings

Banking collections for bonds, foreign currency and bearer bonds

Working knowledge of banking regulations

Researched, created and provided teller training on ATM procedures and protocols, robbery training procedures and protocols and compliance training for all First Bank locations

Education:

St Louis Community College (25 hours in general education studies)

American Institute of Banking

References:

Sandra Morter, MEd, MS, LPC, CCM, MAC

Previous employer-MedPlus

Director, Implementation, Magellan Health Services

acqxqr@r.postjobfree.com

314-***-****

Dr. Dan Morter, BS, DC

Previous employer-MedPlus

Owner, MedPlus