Revenue Cycle Specialist

Caroline Kaburu

469-***-**** ****.*********@*****.*** Royse City, TX

A dynamic Revenue Cycle Specialist, adept in both collaborative and solo settings, excels in billing procedures, insurance claim management, client service, revenue enhancement, and medical documentation analysis, showcasing unparalleled expertise and insight.

SKILLS

● Strong attention to detail

● Excellent calculation capability

● Healthcare billing proficiency

● Microsoft Office tools

● Excellent Communication Skills

● Regulatory Compliance

PROFESSIONAL EXPERIENCE

Revenue Cycle Specialist 01/2022 - Present

Trinetic Healthcare – Dallas, TX

● Resolved complex payment issues such as denials, underpayments or incorrect coding

● Optimized Medicaid claims accuracy, boosting insurance and patient information integrity

● Reached out to insurance companies to verify coverage

● Monitor claim status, research rejections, denials, and document related account activities

● Identified and resolved payments issues between patients and providers

● Determine the most efficient process to resolve refund requests or credit balance

● Identified and billed secondary insurances engaged in reading RA/EOBs and post payment accurately with great attention to detail

● Innovated monitoring and resolution of claim rejections, boosting revenue recovery

● Research missing payments and secure documents needed for posting

● Reduced claim denials by improving insurer communication and dispute resolution

● Track common claims errors, identify and reports inaccurate reimbursement and contractual trends

● Identified billing errors, short payments, overpayments and unpaid claims and resolved them accordingly

● Posts adjustments and collections from insurance companies Revenue Cycle Specialist 03/2019 - 01/2022

Parkland Hospital – Dallas, TX

● Resolves claim edits within the practice management billing system to ensure successful claim submission

● Daily communication with insurance companies and other commercial insurers to address coordination of benefits and claims resolution

● Reviewed EOBs for correct payment, deductible, adjustments and denials

● Sets follow-up activities based on the status of a claim

● Generated receivables reports and offered improvement recommendations

● Reached out to insurance companies to verify coverage

● Work and manage claims from all aging buckets including posting and appeals

● Ability to multitasks and prioritize tasks to accomplish and maintain goals

● Effectively navigate and utilize various healthcare provider software systems

● Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards

● Resolve healthcare claims through verbal or online inquiries to health insurance payers

● Verify accuracy of insurance and patient information

● Verify insurance data entry along with scheduling, and confirming appointments

● Read and interpret insurance Explanations of Benefits (EOB)/Remittance Advice (RA) with understanding and take appropriate steps to resolve issues

Customer Service Representative 02/2017 - 03/2019

General Healthcare Resources – Dallas, TX

● Effectively handled inbound and outbound calls

● Accurately and successfully process service transactions and reached resolution on member issues in a timely and effective manner

● Ability to effectively establish rapport, communicate information and diplomatically respond to inquiries from callers

● Ability to multi-tasks including navigating between computer applications while speaking with participants on the phone

● Tactically handles confrontational or stressful interactions with customers

● Handled customer inquiries and suggestions courteously and professionally

● Actively listened to customers, handled concerns quickly and escalated major issues to supervisor

● Answered constant flow of customer calls with minimal wait times EDUCATION

Kenya Polytechnic University College

Diploma in Marketing and Advertisement

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