Accounts Receivable Project Management
Resume:
Kim Tilghman
Wallingford, PA *9086
Home: 610-***-****
SUMMARY
Self-motivated individual who is resourceful professional and well organized. Strong analytical and interpersonal skills create a solid foundation for problem-solving. Also possess extensive knowledge of medical insurance claims, computer applications and project management. Proficient with numerous insurance carriers, i.e., Medicare, Medicaid, Champus, Auto Insurance, Workmen’s Comp, HMO’s and other commercial carriers.
PROFESSIONAL EXPERIENCE
Mainline Health, Newtown Square, Pa March 2020-Present
Accounts Receivable Specialists
Inform management of any billing, payer trends identified for additional review or escalation.
Follow-up on unprocessed claims by checking payor websites and contacting payors by phone.
Review and monitor work flow in EPIC for Low paid, underpaid, and Denied claims
Responsible for daily AR follow-up on assigned payers to resolve high dollar claims
Utilizes billing system to expedite problematic account resolutions.
Use payer contracts for reimbursement for payments and reconsiderations
UNIVERSITY OF PENNSYLVIANIA, Philadelphia, PA 2003-2015
Accounts Receivable Representative
Generate and send out invoices
Follow up on collect and allocate payments
Carry out billing collection and reporting activities according to deadlines
Review AR aging reports
Research and resolve payment discrepancies
Respond to explanation of benefit denials
KEYSTONE MERCY HEALTH PLAN, Philadelphia, PA 1996-2003
Team Leader (2000-2003)
Facilitate problem solving and collaboration
Intervened when necessary to aid in resolving examiner and provider unit with issues
Cross trained coached and prepared the staff for changes within the healthcare industry
Provided status reports for management
Worked with management to escalate insurance and provider concerns
PROFESSIONAL EXPERIENCE (Continued)
Senior Claims Examiner (1999-2001)
Resolved escalated provider request
Reprocessed over payment hospital projects
Worked suspended claims in denial status
Audited provider and member appeals
Claims Examiner (1997-1999)
Processed all claim types in a timely and accurate manner
Knowledge of processing rules
Written or verbal provider feedback
Resolved routine claims and appeals within 30 days of receipt
Worked suspended claims for payment
Knowledge of all claim types, medical terminology, ICD9, CPT and HCPCS coding
EDUCATION
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Early Childhood Education, Delaware Community College, Upper Darby, PA
COMPUTER SKILLS
Microsoft Windows, Microsoft Word, Microsoft Excel, Type 45 wpm, Medical Terminology, IDX, Encoder Pro, McKesson, Facets, EPIC, Navinet, Promise, Passport, SMS, DRG, ICD9, ICD10, Stockamp (Trac),Epremis, Medasset, Pear Portal, Insurance Web Portals
ACCOMPLISHMENTS
CEU CREDITS
AHAM ACCREDIDATION
MATERNAL FETAL AND NEONATAL CARE
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