Kimberly Kovach, CPC

***** ********* ***** ******** *******, MI 48312 ad0m90@r.postjobfree.com 313-***-****

Qualifications Summary

Dedicated professional with over thirty years in Billing/Coding Operations Management. Extensive knowledge of process optimization and an unsurpassed work ethic. Highly personable Medical Biller with over twenty years of experience in account management claims processing and strong patient advocate skills within the physician office and professional medical billing company setting. I have multiple years of specialized Professional and Facility Medical coding.

Primarily Coding of ICD-10, and CPT/HCPCS codes for both Facility and Professional services for multiple specialty accounts. (Ex: Podiatry, Pain Management, Neurosurgical, Hospitalists and Internal Medicine.)

Expertise in researching accounts receivable and consulting with insurance companies to institute proper adjudication.

Accurately applying electronic and manual payments to accounts within practice management system.

Proficiency in obtaining insurance carrier policies and implementing a billing guideline

Complete knowledge of CPT and HCPCS modifier usage

Efficient with all types of National Correct Coding Resources and Tools

Strong ability to multitask, organize, and accomplish deadlines.

Skillful with Noteworthy NetPractice, Genius, McKesson, Athena, Citrix and eThomas practice management software

Expert with BCBS Webdenis, Navinet, WPS CSNAP, CHAMPS, CMS, Cofinity, Coding Institute, Ingenix Coder, HAP, and various insurance carrier websites.

Proficient with Microsoft Office System (including Microsoft Word, Microsoft Excel, and Microsoft Outlook®).

Professional Experience

Oakland Hills Dermatology – Auburn Hills, MI April 2019 – Present

Billing Manager

Developed policies and protocols for a new Billing department

Oversee the development and implementation of policies and procedures that ensure timely and accurate billing for both insurance and patient

Manage all Billing/Coding operations including:

oEnsure current billing practices comply with government rules and regulations

oPost all insurance electronic and paper payments, including patient payments

oSuccessful submission and collection on claim edits, rejections, denials including level I and II appeals

oWorking NCCI rejections and getting rejections overturned

Responsible for managing patient revenue cycle, including:

oPatient statements, customer service calls, collecting patient delinquent accounts

oIf necessary, create collection files to be sent to agency and monitor files

Train staff daily on verifying eligibility when authorization/referrals are required

Maintain a spreadsheet of PAR insurance carrier and worked all new insurance enrollments

Maintain CAQH validations

Managed biologic billing:

oVerified medical coverage vs pharmacy, obtaining authorizations

oEducated on the medical documentation required

oWorked any billing issues to satisfy the payment

oWorked as a liaison for the pharmaceutical copay assistance programs

Managed all office procedures/surgeries/MOHs, assuring whether authorizations/precert or predetermination was required

Managing practice management EMR systems for all issues

Knowledge of online insurance websites, statusing claims submitting appeals

Stereotactic Radiation Therapy (SRT) claims

oAssist with the authorizations

oPosting insurance payments

oSetting up payment plan

oTaking the patient calls

oMange the practice system access for SRT employees

Working with physician PHO’s

Front desk staff training every day, with insurance changes

Launched new practice management system

Digestive Health Associates – Farmington Hills, MI Feb 2016 – April 2019

Billing Manager

Managed the Billing Operations department for a large GI group of physicians, insurance claims submission and posting of both insurance and patient payments

Managed revenue cycle for all delinquent insurance claims, including working edits/rejections/denials and appeals

Maintained patient statement files, including patient customer service calls, attempt to collect patient debt prior to submitting files to collection agency

Supervised authorization process for biologic claims and maintained spreadsheet with all payments and continued maintaining all authorizations

Educated the entire billing team and physicians on current insurance guidelines along with keeping current with the changes/updates across the board

DMC Medical Group at Sinai Grace – Detroit, MI Jun 2013 – Feb 2016

Billing Team Lead

Audited medical notes for proper CPT and ICD-9 codes for multiple specialties

Posted both insurance and patient payments, including ERA’s and paper checks

Worked edits/rejections/denials and appeals

Maintained patient statements and handled customer service calls and worked delinquent accounts

Prepared and maintained collection agency files sent

Strategic Revenue Solutions – Bingham Farms, MI Nov 2010 – April 2013

Medical Coder/Billing Team Lead

Performed full-cycle medical billing process of both professional and facility services for multiple accounts and locations. (Ex: Office, ER, Outpatient, Inpatient, Observation, ASC and Nursing Homes)

Responsible for credentialing duties, including new enrollments, updates and changes, CAQH attestations

Team lead for billing/patient difficult accounts, assisting with new insurance policies and billing protocols

Client liaison for new enrollment, updating health care changes and any client staff training needed for the medical billing process

Physician Billing Management Inc. – Allen Park, MI Sept 2006 to Nov 2010

Account Manager

Coding of ICD-9 and CPT codes from physician office notes and operative reports

Submit claims electronically and manually for multiple specialty accounts (ex: Bariatric, Podiatry, and General Surgery)

Post electronic and manual insurance payments

Post patient payments

Managed and resolved multiple outstanding insurance accounts

Communicated insurance changes to physicians and office staff

Responsible for all credentialing duties (ex: location and remittances address changes, new enrollment applications, CAQH attestations)

Train employees regarding office policies, practice management system, and billing protocols

Education and Training

American Academy of Professional Coders’ (AAPC) Certified Professional Coder

Dearborn, MI 2009

References available upon request

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