Revenue Cycle Financial Reporting

Kim Buckaloo

Harvest, ***** AL +1-817-***-**** *******@*****.***

Summary

Results-driven healthcare professional with extensive experience in revenue cycle management, denial resolution, and billing oversight across multiple healthcare settings. Skilled in managing complex insurance verification, coding compliance, and claims resolution, while ensuring timely reimbursements and minimizing A/R aging. Strong leadership background in staff training, team management, and cross-functional collaboration, fostering a productive work environment. Proficient in EHR systems (Cerner, Optum) and leveraging financial reporting and data analysis to drive performance improvements. Dedicated to improving operational efficiency, problem-solving, and maintaining HIPAA and OSHA compliance.

Skills

Revenue Cycle Management

Denial Management and Appeals

Billing and Collections Oversight

Insurance Verification

Coding Compliance (ICD-9, ICD-10, CPT)

Claims Resolution

Staff Training and Development

Team Leadership

Front-End Operations

A/R Management

HR Management

Financial Reporting

EHR Systems (Cerner,Meditech,Centricity,CPSI)

Communication and Problem Solving

Experience

QUALITY ASSURANCE ANALYST 08/2021 - Current

Legacy Health

Spearheaded end-to-end denial management across four hospital revenue cycles, optimizing claim resolution processes and accelerating reimbursement timelines.

Facilitated cross-functional weekly meetings with leadership, staff, and clients to drive strategic improvements in production, quality performance, and denial trends.

Authored and implemented standardized operating procedures (SOPs) for the Accounts Receivable department, enhancing workflow consistency and audit readiness.

Designed and led staff training initiatives focused on payer compliance, time management tools, and collections best practices, boosting operational efficiency and team performance.

APPEALS SPECIALIST 10/2020 - 07/2021

Conifer Health Solutions - Frisco, TX

Resolved complex claim denials across commercial, HMO, Managed Medicare, and Managed Medicaid payers, ensuring timely reimbursement and compliance with contract terms.

Drafted and submitted comprehensive appeals for denied claims, leveraging payer-specific guidelines to secure accurate payment and reduce write-offs.

Collaborated with cross-functional teams to analyze denial trends, driving targeted appeal strategies and enhancing revenue recovery outcomes.

Applied deep knowledge of payer contracts to challenge underpaid or denied claims, reinforcing contractual adherence and maximizing collections.

BCBS COORDINATOR 12/2018 - 09/2020

Lubbock Heart & Surgical Hospital - Lubbock, TX

Managed all BCBS and Medicaid claims, ensuring accurate reimbursement through meticulous application of DRG classifications and contractual guidelines.

Executed reconsiderations and appeals for denied claims, leveraging payer-specific protocols to drive successful outcomes and minimize revenue loss.

Delivered hands-on training for new hires on Cerner systems, aging reports, and payer websites, accelerating onboarding and ensuring operational consistency.

Monitored and analyzed aging reports to prioritize high-value accounts, streamlining follow-up processes and reducing claim backlog. INSURANCE COORDINATOR 03/2018 - 10/2018

Livingston Hearing Aid Center - Lubbock, TX

Managed end-to-end processing of commercial and government payer claims, ensuring timely and accurate resolution of hearing aid medical claims.

Led denial management efforts by initiating appeals and disputes, successfully overturning claim decisions and increasing reimbursement rates.

Coordinated pre-authorization workflows for MCO Medicaid patients, securing approvals for hearing aid devices and reducing delays in patient care.

Collaborated with providers and insurance contacts to verify coverage, streamline documentation, and maintain payer compliance across all claim submissions.

APPEAL SPECIALIST 02/2017 - 03/2018

Conifer Healthcare - Frisco, TX

Managed denied claims for commercial, Medicare, and Medicaid payers, ensuring adherence to contractual reimbursement terms and optimizing recovery.

Reviewed and repriced claims using MedAssets tools, validating pricing accuracy and initiating corrections to align with negotiated payer agreements.

Oversaw denial management across three hospitals, submitting adjustments and appeals via the Optum EHR system to resolve complex claim issues.

Tracked and monitored appeal statuses end-to-end, maintaining detailed documentation and improving resolution timelines through proactive follow-up.

AR REP FOR CONIFER HEALTHCARE 10/2016 - 02/2017

Healthcare Scouts Agency - Frisco, TX

Managed accounts receivable for multiple hospitals, resolving new and denied claims across inpatient, outpatient, ER, and diagnostic service lines.

Ensured accurate billing by validating CPT/HCPCS codes and applying appropriate modifiers, streamlining claim acceptance and reducing rejections.

Resolved high volumes of claims daily, consistently exceeding productivity benchmarks with over 55 accounts processed per shift. Demonstrated strong performance and attention to detail, leading to conversion from temp to permanent hire within four months. PRACTICE MANAGER 07/2015 - 06/2016

MAIN STREET MEDICAL CARE - Lewisville, TX

Directed all clinic and billing operations, including staffing, scheduling, and revenue reporting, driving measurable improvements in patient flow and financial performance.

Increased monthly revenue through strategic denial management and appeal submission, securing accurate payments for billed services. Trained locum physicians on EHR systems (eClinicalWorks), coding standards (ICD-9/10, CPT, HCPCS), and end-of-month billing workflows to maintain compliance and consistency.

Led EDI claims monitoring, patient statement processing, and staff development initiatives, including cross-training and incentive programs to enhance team performance and accountability. INSURANCE COLLECTIONS MANAGER 10/2014 - 07/2015

First Choice Emergency Room - Lewisville, TX

Managed Central Business Office teams to ensure accurate claims processing and appeals submission for commercial payers, improving collection outcomes and compliance.

Identified and resolved systemic issues including EDI errors, Tax ID/NPI mismatches, and incorrect corrected claim submissions, reducing delays and denials.

Handled full HR responsibilities including hiring, coaching, performance evaluations, and terminations, fostering a high-performing, accountable team culture.

Delivered weekly Excel-based financial and productivity reports to the CFO, facilitated staff meetings, and led team-building initiatives to boost engagement and operational efficiency.

BILLING MANAGER 02/2014 - 09/2014

Vibra Healthcare - Irving, TX

Managed commercial billing and follow-up teams for 17 hospitals, resolving long-term A/R issues and ensuring timely payer reimbursement.

Analyzed trends and identified systemic issues, including payer ID mismatches and contract discrepancies, leading to faster claims processing and reduced A/R aging.

Collaborated with Directors and CFOs in weekly meetings to review account status, discuss resolutions, and set priorities for ongoing collections efforts.

Oversaw the resolution of SSI system issues, ensuring payer compliance and contract adherence, resulting in improved operational efficiency and reduced claim rejections.

PRACTICE MANAGER 03/2007 - 10/2013

Texas Health Resources - Flower Mound, TX

Managed a multi-physician practice, overseeing coding accuracy for ICD-9, CPT-4, and HCPCS codes, ensuring correct billing provider attribution and minimizing claim rejections.

Directed billing and collections processes, resolving patient disputes and overseeing the correction of billing errors to enhance revenue cycle performance and patient satisfaction.

Coordinated with IT and departmental teams to troubleshoot systems, implement new medical record scanning tools, and train staff on new procedures, improving operational efficiency.

Led HR functions including hiring, performance evaluations, and disciplinary actions, while fostering a positive workplace culture through employee recognition programs and regular staff meetings PRACTICE MANAGER 12/2005 - 03/2007

Medical Edge Healthcare - Irving, TX

Managed daily operations for a two-physician practice, overseeing end-of-day batching, scanning super bills, and uploading charts to the EMR system to ensure accurate recordkeeping.

Coordinated referral processing, ancillary scheduling, and pre-certification for diagnostic tests, streamlining patient care and ensuring timely service delivery.

ASSISTANT MANAGER 05/2003 - 12/2005

Lubbock Urology Associations - Lubbock, TX

OFFICE MANAGER 11/2002 - 05/2003

Heart Surgery Center of Lubbock - Lubbock, TX

Education

Richland Jr. College - Dallas, TX Certificate of Medical Coding 01/1994

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