Billing Manager Claims Specialist
Resume:
Kimberlin Walker
Jacksonville, Fl 32209
Home: 904-***-**** Email: ***********@*****.***
Objective:
To obtain a career opportunity that will allow me to demonstrate and grow my customer services, communication skills proven by over 20 years of successful experience in the medical healthcare field.
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Qualifications and Skills:
•20 years of experience in Customer Service
•18 years experience in Insurance Billing, AR collections
•15-17 years in Front and Back end Office Operations
•Proficient in Multiple PC Software System
(Word Processing, Spreadsheets, Databases, Misys, Intergy…)
•Knowledge of claims payment laws, medical terminology, revenue and billing procedure •Proficient with the manual of Current Procedural Technology (CPT) issued by the American Medical Association,International Classification of Diseases (ICD)
•15 Years experience in Balance Sheet and Management Status Reports
•7 Years Experience in Posting payment and managed the collection process
Education:
Sawyer Business School of New Jersey
Business Administration Assistant 1985-1986
Professional Work Experience
South Point Surgery Center 2017- Present
Account Receivable Representative
•Collected on past due balances and made payment arrangements on patient accounts
•Reviewed accounts for possible assignment and made recommendations to the Billing Supervisor
•Prepared information for the collection agency.
•Completed registration process and other admission finance functions
•Verified insurance, co pay and deductable
•Completed accurate registration processes including verification of insurance benefits pre certification and calculation collection of monies due.
•Maintained strictest confidentiality; adhered to all HIPAA guidelines/regulations
Career Achievement
•Provided a high level of customer service and relations based on outstanding communication and interpersonal skills.
•Reputed as a competent go to person in my team; coached team members on how to achieve high goals, transition customer frustration into a positive experience.
•Received numerous letters of recommendation, and appreciation from customers, and management.
•Drove revenue growth, uncovering new techniques ‘opportunities and building excellent relationships with high-profile clients, telecommunication, processor, and storage accounts
Riverside Spine & Pain Physicians, Riverside Surgical Center 2016 - 2017
Claims & Authorization Rep
Preparing Paper work for authorization for patient surgery getting authorization from carrier
and making sure procedure codes are covered under the policy
Follow up on A/R making sure claims get paid properly
Making sure Authorization last for the time length they are needed.
South East Orthopedic Specialist 2015 - 2016
Claims Specialist
•Reviewed patient accounts to ensure timely receipt of payment.
•Followed up on insurance billing to guarantee timely receipt of payments
•Demonstrated proper manner of dealing with patients and insurance companies.
•Interpreted properly insurances fee schedule to exploit and insure a proper payment posting.
•Identified overpayment and audited reports received from external source
•Understood and interpreted the EOB claims processing procedures, medical policies; contract and payment policies for all designated lines of procedures bills.
•Prepared and submitted clean claims to various insurance companies either electronically or by paper
21st Century Oncology 2010- 2015
Claims Specialist:
•Processed insurance claims and resolved billing issues for insurance companies, healthcare providers and hospitals
•Received inbound and outbound calls to patients and health care providers.
•Investigated and appealed pending claims and resolved discrepancies
•Maintained the Claims Management Payor system (CMS) and executed extensive analysis of variances for contract rules validation and underpayment collections.
•Tracked and trended Denial reports to identify root causes for denied claims and optimized recovery efforts
•Researched and audited physician charges/accounts receivable with and extensive knowledge of reimbursement and billing requirements and regulations
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Integrated Community Oncology Network, Patient Account 2006-2010
Specialist Oncology Group:
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•Reviewed patient accounts to ensure timely receipt of payment.
•Followed up on insurance billing to guarantee timely receipt of payments
•Demonstrated proper manner of dealing with patients and insurance companies.
•Interpreted properly insurances fee schedule to exploit and insure a proper payment posting.
•Identified overpayment and audited reports received from external source
•Understood and interpreted the EOB claims processing procedures, medical policies; contract and payment policies for all designated lines of procedures bills.
•Prepared and submitted clean claims to various insurance companies either electronically or by paper
Jacksonville Orthopedic Institute 2003-2006
Account Receivable Representative:
•Collected on past due balances and made payment arrangements on patient accounts
•Reviewed accounts for possible assignment and made recommendations to the Billing Supervisor
•Prepared information for the collection agency.
•Completed registration process and other admission finance functions
•Verified insurance, co pay and deductable
•Completed accurate registration processes including verification of insurance benefits pre certification and calculation collection of monies due.
•Maintained strictest confidentiality; adhered to all HIPAA guidelines/regulations
Career Achievement
•Provided a high level of customer service and relations based on outstanding communication and interpersonal skills.
•Reputed as a competent go to person in my team; coached team members on how to achieve high goals, transition customer frustration into a positive experience.
•Received numerous letters of recommendation, and appreciation from customers, and management.
•Drove revenue growth, uncovering new techniques ‘opportunities and building excellent relationships with high-profile clients, telecommunication, processor, and storage accounts.
References: Personal and Business references
1 Valencia Pratt Billing Manager 21st Century 904-***-****
2 Angela rodriquez Team Leader Icon 904-***-****
3. Jvonshatta Bland Billing Manager South Point Surgery Ctr 904-***-****
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