Kathryn Askari

ad0alm@r.postjobfree.com

Plano, TX ****5

Professional Experience:

Spectra Force/ AbbVie Pharmaceuticals - Contractor December 2022-February 2023

Insurance Specialist 1 (IS1)

Provide insurance coverage verification details prior to authorization statues and alternate funding options for

existing and newly launched products. Provide offices with current plan forms, portals, and websites for prior authorization and appeal submissions.

Cognizant Technologies December 2020- November 2022

Senior Executive Claims Examiner

Job Duties:

Team mentor to less experienced examiners for audit questions, guidance, and policy interpretation.

Resolved medical claims edits in the QNXT system for service authorizations.

Reviewed claim for timely filing, checked for duplicate bills in history.

Reviewed member's coverage for primary or secondary insurance coverage.

Applied primary coverage benefits from explanation of benefits attached to claim.

Queried enrollment for coverage of newborn members. Requested system update to ensure claim coverage.

NTT Data Services (Tufts Healthcare) Contractor April 2019 – June 2020

Senior Claims Examiner

Physician Signatures and Duplicate Billings

Resolve medical claims suspended in system for service authorizations.

Review for timely filing, physician signatures, and duplicate billings

Review insured’s contract to assure benefit coverage for billed services

Review claim audits and report trends to management team

Medical Practice Solutions (Cornerstone Staffing) Contractor October- December 2018

Medical Claims Auditor

Billing and Auditing Claims for team members to assure that all charges were captured.

Daily download of EDI Report to evaluate and resolve reasons for non-acceptance by system.

Resubmit claim corrections, drop claims to CMS 1500 if no MPI number assigned to provider.

K FORCE- Gaffey Health Systems (Contractor) May 2018- August 2018

Rural Health Billing Specialist

Prepare and submit clean claims to insurance companies electronically /or paper in an accurate, timely, and compliant manner.

Collect and verify all documentation for timely billing of patient accounts including requesting and collecting medical records to ensure acceptance of the claim by the clearinghouse.

Worked daily billing reports, work lists, hold reports, and claim rejection errors. Follow up on claims held for information, resolve claim edit errors per billing guidelines.

Process claims for secondary insurance carriers by accessing EOB’s online and applying payments, as well as discounted amounts patient copays and deductibles.

Access claim uploads from providers for current day, work claim edits, and submit to clearinghouse to complete processing.

Enter total facility charges into Excel spreadsheet to balance with claims submitted, edited and denied.

Texas Oncology- Richardson, TX (Contractor) September 2017- January 2018

Senior Claims Examiner

1.Assign batch number, notating date of charges, and office site number.

2.Enter each patient daily charge in Mysis System for oncology visit, chemotherapy drugs administered. Also separately code pump rentals, calculate units by days rented.

3.Print off daily batch summaries, forward drug charges to onsite clinical pharmacy

4.Using excel spreadsheet, enter CPT codes and units for each charge ticket.

5.When charges on batch summary matched with spreadsheet totals, released batch to be billed out to insurance companies.

Methodist Hospital & Texas Health Resources August 2014- August 2017

Obstetrics Hospitalist Group Medical Biller and Coder (Methodist) and TX Health Resources( Denton)

Job Duties:

Assisted with medical coding and charge entry and reviewed medical records for billing.

Researched and resolved documentation issues on accounts, notified physician for clarification and completion.

Matched and verified patients treated in the Obstetrics Emergency Department in HMS spread sheet such as medical record number dates of service, procedures performed, and notated in Excel spread sheet as assigned to me.

Extracted demographics, medical records, downloaded operative reports from TXHR HMS

Updated claim statuses in the HMS system, indicating any unusual circumstances.

Always maintained HIPPA Guidelines as well as hospital security regulations.

Dell Perot Systems June 2010-Dec 2012

Senior Medical Claims Examiner Automated

Automated claims processing for Kaiser Permanente Health Plan during system conversion.

Data entry of medical claims into claim processing system, apply contract guidelines, approve, or deny any line items or non-covered.

Enter specific coverage codes or denial codes per line item.

Contacted provider to request medical records necessary to make claims coverage decisions. Followed up within 30 days. Reviewed records when received.

Completed a weekly report on the number of claims paid for certain groups, number of suspended claims, and number of denials.

Health Special Risk Sep 2006- Aug 2009

Senior Medical Claims Examiner

Processed claims for 19 universities. Processed claims per policy guidelines, apply ICD-9 and CPT codes.

Applied contract benefits and adhere to policy guidelines regarding covered and non-covered benefits.

Requested and reviewed medical records. Released for payment or send letter outlining reason for denial to both provider and claimant.

Education:

Collin Community College McKinney, TX 2012-2015

Health Information Technology Program-Medical Coding and Billing

Richland College Dallas, TX 1975-1978

Associate of Accounting

North Lake College Irving, TX 1992-1993

Claims Adjuster Courses to Qualify for Texas Multi-line Adjusters License

Texas Multi-line Adjuster’s License 1993-2007

Skills: Microsoft Excel, Electronic Medical Records, Health Information Management, Records Research, Intuitive people skills.

Leadership Skills: Ability to collaborate with the team. Audit mentor to team members with less experience - less experience.

In order to achieve better Quality Review Scores, I retrained the team .

Results: Scores went up from 82% to 98%.

Has research/ analytical problem -solving skills, excellent verbal, and written communications skills.

Systems experience: Diamond, MediTech, Epic, TriZetto, QNXT, Epic, Citrix, DataNet, QicLink

Name

Address

Email

Phone

Will you accept $16.00 – 16.75 (Y/N)

1.Have you ever worked for/interviewed with Perot Systems, Dell, or NTT Data?

a.If so, what client/customer account did you support?

b.What was/is the project end date?

c.What is the name of your current/last NTT Supervisor/Manager?

2.Have you been communicating with anyone at NTT Data regarding other positions? (Y/N)

3.Are you currently working? (Y/N)

a.If yes, how much notice are your required to give?

4.Do you have High School Diploma/GED? (Y/N)

5.How many years of experience in Medical/Healthcare/Health Insurance industry?

6.Please provide years of experience:

a.Physician Credentialing

b.Provider Data- Management, Maintenance, Verification, Enrollment, or Analytics

c.Medical Claims Processing

d.Physician/ Health Plan Contracts

7.What is your experience level with Microsoft Excel? (Beginner, Intermediate, Advanced, Expert)

a.Which of these have you used in past 2-3 years: Cactus, Facets, Citrix, Verintt, ZOOM, Sharepoint, One Drive, MS Outlook, MS Teams?

b.What other programs/systems have you worked with in the last 2-3 years?

8.Are you comfortable working with PC, navigating screens, learning new software tools (Y/N)

a.Have you participated in virtual training in a prior position? (Y/N)

9.Do you have a dedicated & quiet workspace (Y/N)

10.Are you available to work regular hours (M-F) 8:00am – 4:30pm EST (Y/N)

a.Do you agree to participate on video during training? (Y/N)

11.Have you worked remote/from home? (Y/N) If yes, when/where?

12.Available to start October 2nd 2023 or after? (Y/N)

13.Do you have any prescheduled time off during the next 6 months (Vacation, doctor, etc.) (Y/N) If yes, when?

a.Vacation is not allowed during the training class. Do you accept? Y/N

14.What is your availability to speak with me today and tomorrow?

Michelle Reasor Talent Acquisition Advisor NTT DATA +1-214-***-****

Contact this candidate