CPC, Medical Insurance Specialist, Microsoft Office, PSR Provider Svc.

KIM D. LOKKEN, C.P.C.

**** ****** ***. ******** ** 48433 · 810-***-****

ada1te@r.postjobfree.com · www.linkedin.com/in/kimlokkencpc

I am seeking a long term position as a Medical Insurance Specialist. I am a Certified Physician Coder, certified by the (AAPC) since December 2009. I stay current on my coding skills by attending AAPC Membership meetings and seminars. I also subscribe to the Healthcare Business Monthly magazine to further my education and to obtain CEU’s. I am detailed oriented, organized, problem solver and dependable.

EXPERIENCE

08/2012 – CURRENT

PROVIDER SERVICE REPRESENTIVE, Mclaren health plan

* Assist providers with claim status, eligibility, benefits, authorization status, by telephone, internet and fax transmissions. Work with professional and facility claims.

* Claims Analyst II and data entry fast pace with accuracy. Proficient in “Health Rules" software program. Entered claims information, primary and secondary EOP information.

* Provide claim status on paid and denied services, determined if adjudicated accordingly or denied in error.

* Identify underpayments and researched numerous fee schedules to verify fees and contract information.

* Reviewed computer data to ensure provider records information is entered accurate and up to date. Notify Network Development team with any discrepancies.

* Quote patients benefits and guidelines. Researched various types of benefits. Provide deductible, coinsurance and total out of pocket amounts to the provider.

* Assist providers with authorization information. Completion of forms, how to navigate MHP website.

* Investigation of all denied reason codes. Review authorization entries and dates listed on authorization to verify accuracy of computer entry. Able to recognize data entry errors.

* Knowledgeable in anesthesia claim processing, modifiers, anesthesia times and calculating fee.

* Knowledgeable HIPPA guidelines certified yearly. Follow AAPC coding guidelines, CPT, ICD-10. Knowledge of modifiers and HCPCS classification system guidelines.

* Able to recognize billing errors. Will use reliable resources for further investigation if needed.

11/2009 – 08/2012

MEDICAL INSURANCE SPECIALIST AND CODER, community podiatry group

* A/R posting. Responsible for claims EDI transmission. Knowledge in software program "Colonial Valley". Ran numerous reports front end edits and responsible for collection report, mailed out notice to patients. Imported files EDI.

* Experience in facility and professional claim billing. Abstracted data from patient charts by using CPT, ICD-9, ICD-10 and HCPCS classification system guidelines.

* Made outbound calls to hospitals and insurance companies to research and gather necessary information for successful claim resolution. Status authorization/pre-certifications.

* Communicated with patient’s to have a clear understanding of their medical insurance benefits and policy guidelines. Explanation of payment and terminology of EOP explained.

* Submitted authorization as needed and filed appeals.

* Knowledgeable of third-party payers, HMO, state programs MDCH and private insurances.

09/1988 – 09/2009

QUALITY CONTROL INSPECTION/PRESS OPERATOR, Cadence Innovations, L.l.C.

* Proficiency in quality control.

* Worked directly with new business suppliers to ensure quality product.

* Trained new employees.

* Automotive spray painter, fine line masker, and molding department press operator experience as well.

EDUCATION

06/2007—06/2009

MEDICAL INSURANCE SPECIALIST, baker college of flint

Associate Degree of Applied Science

Dean & Presidents List/GPA 3.43

04/2009—06/2009

MEDICAL INSURANCE SPECIALIST, Hurley Medical Center

Physicians Billing Department – College Externship Program, completed 180 hours.

12/2009 - CURRENT

CERTIFIED PROFESSIONAL CODER (CPC), AAPC American academy of professional coders

Member of American Academy of Professional Coders (AAPC) since July 2009.

Received ICD-10 Certification December 2010.

SKILLS

CPC Certified Professional Coder

Microsoft Word and Excel

Filing

Customer Service

Typist 60 WPM

Medical Terminology

Human Anatomy

Bookkeeping

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