Kim LaPlante

Avondale, AZ *****

adce6k@r.postjobfree.com

602-***-****

Initiative-taking, meticulous, and customer-service driven healthcare professional with over 13 years of progressive medical claims experience. Seeks to contribute to the overall success of an open, all- inclusive, forward-thinking organization by utilizing key relationship building skills and extensive healthcare industry knowledge.

Work Experience

MEDICAL CLAIMS SPECIALIST

Jewish Family Children Service

April 2019 to Present

Processes all AHCCCS, RBHA, Medicare, commercial insurance and ALTCS claims follow require procedures; provide all necessary follow-up including Collections on outstanding claims. Research and follow up to resolve denied claims, make note in the billing system to documents the progress, Work the aging reports. Post all third-party payments. Update client insurance information.

MEDICAL CLAIMS REVIEWER

TriWest Healthcare Alliance - Phoenix, AZ

December 2014 to June 2018

• Reviewed, evaluated, authorized, and monitored services provided and received through the Veteran's Choice Program.

• Assumed responsibility for maintaining HIPAA compliance with regards to billing and coding practices

• Examined all complaints and grievances received from veterans to determine course of action to resolve their issues

• Assisted with special projects collaborating with providers on their accounts payable and accounts receivable processing and procedures

• Manage inbound phone call from Veterans VA and other customers, Performs claims research and resolution regarding both Institutional and professional claims. Reviewed billing issues. Worked and detailed fast pace production environment.

MEDICAL CLAIMS ANALYST II

Care1st Health Plan of Arizona - Phoenix, AZ

January 2014 to September 2014

• Maintained, completed, and updated key resource materials necessary to effectively process claims

• Settled claims in accordance with health plan guidelines, company standards, and processing procedures

• Implemented and applied medical cost containment procedures and guidelines to providers of medical care and utilization practices

MEDICAL SENIOR CLAIMS BENEFITS SPECIALIST

Aetna Health Care of Arizona - Phoenix, AZ

December 2006 to November 2013

• Reviewed and adjudicated specialized claims for new line of business

• Performed the role of subject matter expert by providing training for colleagues

• Assisted with the backlog in other areas of the company, such as refunds and encounters Education

High school diploma in BUSINESS

State Regulations - London

November 1975 to January 1978

Skills

• Medical Billing

• ICD-9

• CPT Coding

• ICD-10

• Microsoft Outlook

• EMR Systems

• Medical Office Experience

• Medical Terminology

Certifications and Licenses

NONE