Medical Insurance, medical claims, patient accounts, customer service
Resume:
KIMBERLY DOUGLAS
Collierville, TN 38017
********@***.***
Dependable, multi-tasked, individual with the ability to operate at a maximum efficiency in a fast paced environment.
QUALIFICATIONS
History of effective problem solving and increasing productivity. Background includes a diversity of strengths in a medical setting in areas including:
Medical Terminology
General knowledge ICD9 and CPT-Coding
Research and problem-solving
Oral and written communication skills
Medical Transcription
Working knowledge of all facets of insurance requirements
Ability to organize and prioritize work
Other skills and abilities include:
Using on-line Network and PC Systems with software including Microsoft Word, Excel, IDX, Outlook, Cerner, FileNet, Avaya; HERO; Delair; RightFax; PASS
WORK HISTORY
KINETIC CONCEPTS INC Jun 2015 to Nov 2016
5800 Farinon Dr. Bldg IV
San Antonio TX 78249
Supervisor Cynthia Miller
Office 210-***-****
*******.******@****.***
HEALTHCARE INTAKE SPECIALIST
Qualified orders for placement based on payers requirements. Acts as the liaison between the customer, KCI, and third party payer to ensure the order meets regulatory and payer requirements. Obtain and analyze required documentation for shipping of product and billing of claims.
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SOUTH TEXAS VETERANS ADMINISTRATION Jan 2015-Jun 2015
8410 Data Point Dr
San Antonio TX 78229
Supervisor Sharon Benitez
Office 210-949-8900x65475
******.*******@**.***
MSA (MEDICAL SUPPORT ASSISTANT)
Responsible for scheduling appointments, including interpreting and verifying provider orders in accordance with VHA national scheduling guidelines. Assignments included scheduling, canceling, re-scheduling patient’s appointments and/or consults; entering no show information; assisted with monitoring the electronic wait list; facilitated and assisted with patient travel activities; verified and updated demographics and insurance information; gave
advisory and technical assistant to all applicable customers regarding eligibility and enrollment services, programs and activities; accurately interprets eligibility requirements in order to make eligibility determination to ensure that veterans and beneficiaries meet legal/contractual requirements for medical care; processed all emergency and non-emergency transfers to other VA facilities and non-VA hospitals and facilities; communicated pertinent information to patients, co-workers and clinical staff members; provided clerical support to include but not limited to preparing/mailing letters, placing phone calls, printing labels/armbands, maintaining/updating rosters and phone lists, and running various reports; performed accurate eligibility assessments, co-pays and preauthorization requirements for specific coverage.
UNIVERSITY HEALTH SYSTEM Jan 2009- Nov 2016
4502 Medical Drive
San Antonio TX 78229
Supervisor Cindy Marek
Office 210-***-****
Central Lab Facility Clerk
Receive and process samples that are submitted to laboratory for analysis. Performs duties required for computer order entry of tests requests. Retrieves patient test results from the lab computer and provides to clinicians verbal test results on which medical action will be based. Handles inquiries pertaining to specimen collection requirements and other lab test information. Serves as a receptionist to patients and visitors.
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KINETIC CONCEPTS, INC May 2009-Jan 2015
5800 Farinon Dr. Bldg IV
San Antonio TX 78249
B18.35/E19.08
Martha Gonzalez-ph210-406-5166
Healthcare Intake Specialist-Full time
Act as a contact person for the field personnel, medical professionals, patients, and claims carriers to facilitate the organization of paperwork required for processing DME claims. Verify member insurance benefits/eligibility online and through auto-mated phone system; Communicates with facilities and clinics to request referrals and medical documentation as needed for DME requests, including contacting insurance providers to initiate authorizations; Review insurance information entered by order entry dept for accuracy; Remains informed of new insurance guidelines and procedures for medical review; Collect and review incoming medical documentation by verifying ICD9 codes and insurance requirements noting acceptance in system. Accurately and completely documents communications and transactions between the
facilities, internal, and external customers. Escalates issues and situations within practice management; Responds to phone calls, emails and faxes from
internal and external customers; Manages transition process by working with discharge planners and case managers to ensure initial paperwork is properly complete and ensure timely release of delivery of DME products. Tracks orders
until payer and internal requirements are met for billing by monitoring bill pending reports to ensure collection of documents in a timely manner by following up with physician offices, home health agencies, wound clinics, hospitals, and patients. Assist in the resolution of accounts beyond authorization date; Coordinate and communicate with customers and service staff regarding asset, delivery, and pick up.
KINETIC CONCEPTS, INC. Sept. 2005-May 2009
1801 North Shelby Oaks Dr.
Memphis TN 38134
B15.00/E18.35
Eva Vasquez-ph210-406-4849
Coordinator of Patient Administration (COPA)-Full time
Point of contact for the field, acute facilities, clinics, and home health agencies to meet client needs. Monitored unbilled document issues report and collected missing information for billing. Assisted in the resolution of DME orders beyond authorization date; monitored pending report daily and maintained Bizflow system application to ensure complete documentation was obtained. Assisted internal departments with retrieval of documents, resulting in certification and recertification of DME products and therapies. Ensured timely processing of required paperwork to prevent delays in delivery, billing and recovering of DME products; Assisted in identifying patients transitioning between care settings (e.g. Acute to Home); Coordinated DME products for delivery; Ensured seamless transition of product placement.
EDUCATION
Everest Institute-2008 to 2009
Medical Billing and Coding-Diploma
6550 First Park Ten Blvd
San Antonio TX 78213
GPA 3.9
Northwest Mississippi Community College-1991 to1994
Associate of Applied Science Degree in Medical Office Technology
US Highway 51
Senatobia MS 38668
Medical Office Technology-Associate Degree
GPA 2.5
ACTIVITIES
Kinetic Concepts, Inc. Habitat for Humanity Sept-Oct 2008
Attended San Antonio Medical Managers Seminars (SAMM)
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