KIM TURNER

***** *** **** **.

Houston, Texas ***95

281-***-****

EDUCATION: Houston Community College, Houston, Texas

Certified Pharmacy Tech, 1990

Mansfield Business College, Houston, Texas

Certified Word Processor, 1986

WORK EXPERIENCE:

06/10 – 03/11 Healthcare Payment Specialist, LLC

Claims Analyst II

• Prepares appropriate reports, as required by respective accounts.

• Research, audit, and analyze Inpatient Medicare and Medicare

Advantage Plans Transfer DRG claims to identify over-payments

and underpayments.

• Import Medicare Claims Data into Access Database.

• Assist with creating and implementing Inpatient Medicare TDRG

process.

• Direct and assist with rejected and RTP Medicare claim issues.

• Process appropriate Inpatient claims through Medicare TDRG Pricer.

• Knowledge of CPT, ICD-9, Reason Codes, Revenue Codes,

Discharge Disposition Codes, and CMS guidelines.

09/07 – 01/10 MCare Solutions Inc, Houston Texas

Senior Claims Researcher/Operations Manager- East Region

• Prepares appropriate reports, as required by respective accounts.

• Knowledge of CPT, ICD-9, Reason Codes, Revenue Codes,

and Discharge Disposition Codes.

• Research, audit, and analyze Inpatient Medicare and Medicare

Advantage Plans Transfer DRG claims to identify over-payments

and underpayments.

• Processed Medicare Electronic Claims Adjustments through Fiscal Intermediary Standard Systems (FISS)

• Submitted Appeals for Medicare Managed Care Claims.

• Maintains appropriate communication by keeping both Internal

Director and over 100 clients apprised during the course of

research.

• Directs, Counsels, and instructs staff members assigned to research, and reviews their work for sufficiency of scope of accuracy.

01/07 - 09/07 Sava Senior Care, Houston, Texas

Intake Coordinator

• Medicare remote system to determine SNF days available.

• Verify insurance and obtain pre-cert for Medicare managed care.

• Take incoming calls from all referral sources.

08/02 - 08/06 Triumph HealthCare Hospital, Houston, Texas

Admission/Business Office Coordinator

• Coordinate outpatients pre-admission, scheduling, pre- cert.

• Obtain insurance verification information and collect copays/deductible

• Developed outpatient admission policy and procedures for new

start up facility.

• Verified all Medicaid information on TDH Connect.

• Verified all Medicare information in Mutual of Omaha Passport system

• Charge entry and post payments to patient accounts for month end

close.

• Responsible for ADP payroll edits and Accounts payable

03/01 - 08/02 Texas Children's Hospital, Houston, Texas

Admission Counselor

• Obtain and verify insurance information.

• Coordinate and administer patient referrals for specialist visits.

10/98 - 03/01 Columbia HCA Hospital, Houston, Texas

Admitting Rep II

• Admitting and pre-admitting for outpatient, inpatient, and day surgery.

• Interpreting insurance information and preparing patients charts.

• Collect patients co-pay and deductibles.

10/97 - 10/98 Memorial Hermann Hospital, Houston, Texas

Ambulatory Office Representative

• Preformed patient scheduling, registration, insurance authorizations,

and collect co-pays for a large Family Practice Clinic.

04/93 - 10/97 Harris County Hospital District, Houston, Texas

Registration Clerk III(Eligibility Service Representative)

• Evaluated patients documents presented for eligibility.

• Preformed third party billing.

• Preformed administration of patients accounts information.

• Obtain Pre-Certification Information.

References and Letter of Recommendation Furnished Upon Request

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