Revenue Cycle Patient Care
Resume:
Kimberly C. Lewis
Cell: 203-***-****
**********@*****.***
Professional Summary:
Eager to transition to a health care administration role. Continue to adhere to SHMG’s organizational values. Seeking opportunity and commitment to quality patient care and adaptability in a challenging administrative environment. Continuing with a high level of service proven track record of relationship building, collaboration, systems maintenance, and management; high degree of organization, accuracy, communication skills and commitment to deadlines.
Microsoft: Word, Excel, Access, Outlook, PowerPoint; Adobe Pro, eClinical Works, Meditech, Vistar, SharePoint, Salesforce, Navicure/Waystar, Ingenious Med, and Tableau. Strong points are helping and training new employees, team leadership and development, assisting with process improvement.
Experience:
2015 - Present
Stamford Health Medical Group, Inc.
Stamford CT
Central Billing Office - Revenue Cycle Specialist - Denials
Supports the Accounts Receivable team by researching, resolving, and resubmitting denied claims within timely filing limits.
Research and review scanned correspondence for additional requests for information.
Resolves denials by submitting documentation for appeals.
Resolves rejected claims and incorrectly paid claims.
Communicate with billing for claim issues from practice.
Submit inquiries to coding for correct CPT, HCPCS and understand NCCI edits.
Research patient inquiries from customer service
Understand and interpret various forms of explanation of benefits from Commercial insurance carriers, Medicare, Medicare, Skilled Nursing Facilities, and CHAMPUS.
Appropriately verify patient eligibility
Recognize and report denial trends and work with management to fix.
Work well with team members and management by communicating and educating when new trends arise.
Central Billing Office - Revenue Cycle Associate – Aging Claims
●Submit approximately 2,000 medical claims to the clearinghouse per day to ensure insurance companies receive them in a timely manner.
●Correct errors on clearinghouse and insurance rejected claims for resubmission.
●Manually and electronically verify the acceptance of files submitted to the clearinghouse.
●Created workflow to have manual claim batches to run automatically and submit electronically.
●Created workflow / handbook and trained new staff.
●Research aging claims over 30 days by calling to confirm if claims have or have not been received and using payer provider portals.
●Reach out to payers to obtain EOB, EOP and ERA, verify cashed checks, credit card payments and V-Payments from Zelis and PNC.
●Investigate and retrigger failed visits for Ingenious Med and reconcile failed visits for Neurology, Cardiology and Breast Imaging specialties.
●Reconcile non-coding claim edits.
●Merge duplicate patient accounts weekly to avoid failing claims and creating errors.
Revenue Cycle - Credentialing and Enrollment Associate
●Assemble, organize, and present factual provider information derived from a variety of original and secondary sources.
●Accurately complete the enrollment/reenrollment processes as outlined by each payor for all appropriate healthcare providers to ensure timely and continued provider network participation.
●Maintain thorough documentation of each stage of the enrollment/re-enrollment process.
●Process appropriate queries for expired licensure, or any appropriate regulatory credentialing requirement and maintained appropriate documentation.
●Maintain detailed provider credential and enrollment files in appropriate format, paper and/or electronic including electronically received documents and scanning of hardcopy documents.
●Maintain provider NPI information via the NPI Registry website.
●Provide timely and thorough follow up of pending applications.
●Accurately update and maintain all internal systems and resources with appropriate provider and network participation information.
●Develop and maintain good working relationships with the organizations providers and support staff to obtain necessary and timely information to facilitate the provider enrollment/reenrollment process.
●Respond to and resolve problems with provider numbers and/or participation status as it relates to denial of services or reimbursement by working closely with all levels of administrative and clinical personnel and payor representatives.
●Responsible for educating providers, administrators, and support staff regarding the enrollment/reenrollment processes and how it relates to the provider's ability to provide care to network members in order to increase reimbursement and reduce patient dissatisfaction.
●Created Credentialing handbook of policies and procedures.
2014 - 2015
Stamford Health Medical Group, Inc.
Stamford, CT
Receptionist/Scheduler: Colon and Rectal Practice - Temporary - Excel Partners, Inc
●Greet and direct visitors/patients for the Colon and Rectal Practice.
●Obtained, verified, and scanned patient demographic information in eCW.
●Scanned all referrals, colonoscopy reports and images correctly to eCW.
●Assisted with answering and screening calls.
●Scheduled appointments, record, and forward messages as required.
●Prepared pre-op information for patients
●Verified surgery scheduling with Operating Room
2014
Stamford Hospital – Clinical Trials
Stamford, CT
Data Entry - Temporary – Flu Campaign - Excel Partners, Inc.
●Verify, load and correct patient demographics, enter flu vaccine dates and payments into Access database.
●Create excel spreadsheet for resolution of Managed Medicare clients and document actions taken to resolve payments.
●Perform database clean-up and run queries for billing.
●Reviewed EOBs for denials, for Medicare and Commercial Insurances, printed and mailed corrected Form 1500 to insurance of patient.
Education
Bachelor of Science May 2022 Charter Oak State College
Business Administration - Honors New Britain, CT
Certifications
Medical Billing and Reimbursement (Certificate) Norwalk Community College
Norwalk, CT
AAPC Member Danbury, CT
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