Receivable Specialist Revenue Cycle

Kenel Bakula

Florence Kentucky, Phone: 734-***-****, Email:*************@*****.***

Experienced Revenue Cycle Specialist with 6 years of expertise in compliance, maximizing collections, and claim denial management. Skilled in working both independently and as part of a team to enhance revenue and ensure diligent follow-up of claims.

EXPERIENCE

Account Receivable Specialist

Trinity Health Solutions, Remote

March 2024 – April 2025

● Resolved claims promptly by completing appeals or delivering necessary documentation and account details to payers

● Monitored claim status daily, investigated denials and rejections, and documented all related account activities in the system

● Identified issues with claim submissions and collections, proposed solutions, and implemented process improvements

● Accurately reviewed and interpreted Explanation of Benefits (EOBs) to determine denial reasons for specific CPT codes

● Reviewed patient balances for accuracy and performed follow-up to secure patient payments and resolve discrepancies

● Researched underpayment denials and recommended potential resolutions to maximize reimbursement

● Analyzed denial reasons on payer portals and took appropriate steps, including sending appeals or submitting requested documentation

● Tracked incoming payments from both government and commercial payers, ensuring timely and accurate posting

● Resolved denied claims by preparing appeals, submitting additional records, and contacting payers for clarification or correction

● Maintained accurate and complete documentation on all accounts while managing incoming correspondence related to claims

● Managed a high volume of daily claims, consistently meeting performance and accuracy benchmarks

● Contacted responsible parties including patients and insurers to follow up on outstanding invoices and balances

● Oversaw and prioritized high-dollar balances in the daily work queue to focus on time-sensitive collections

● Collected and posted payments for all assigned divisions, ensuring alignment with EOBs and payer remittance advice

● Dispatched appeals to appropriate payers based on specific denial codes and guidelines for reimbursement

● Conducted outbound calls to insurance carriers to verify coverage, check eligibility, and resolve claim status issues

● Acted as a resource for internal staff by answering billing-related questions and assisting with reimbursement challenges

EXPERIENCE

AR Follow up Representative, Remote

Davita health - November 2022 - March 2024

●Resolved claims promptly by completing appeals as necessary or delivering materials and accounts to the Payer

●Monitored claim status, investigated rejections and denials, and documented related account activities

●Identified potential issues with claims and collections, implementing solutions for improvements, and accurately reviewed and interpreted Explanation of Benefits to determine denial reasons for specific Current Procedural Terminology Codes

●Reviewed patient balances to ensure accuracy and followed up with patients to obtain payments

●Identified potential resolutions for underpayment denials from payers

●Analyzed denial reasons on payer portals and implemented appropriate resolutions to ensure proper reimbursement of payments

●Tracked payments from commercial and government payers

●Resolved claim denials by taking appropriate actions on claims, which included sending appeals, responding to medical records requests, and researching resolutions

●Ensured accurate documentation for all accounts while addressing correspondence to resolve outstanding claims

●Efficiently managed a high volume of claims daily

●Contacted responsible parties to secure payment for outstanding invoices

●Oversaw daily work queue to prioritize high-dollar claim balances

●Collected the dollar amount of all invoices for assigned divisions and accurately posted payments according to Explanation of Benefits received

●Dispatched appeals to relevant payers based on denial reasons for reimbursement

●Conducted outbound calls to insurance companies to verify coverage, eligibility, and claim status

●Acted as a resource for staff inquiries related to billing or reimbursement issues EXPERIENCE

Account Receivable specialist II, Remote

Savista - February 2022 - October 2022

●Developed invoices to fulfill client requirements

●Produced comprehensive billing for Managed Service Provider clients

●Initiated accounts payable payments for affiliated vendor transactions

●Generated Accounts Receivable aging reports

●Initiated communication with new clients upon receiving their first invoice

●Initiated contact with clients nearing 30 days to provide additional support

●Drafted updated client invoices when necessary

●Oversaw the company's accounts receivable and identified overdue accounts

●Engaged with clients holding overdue accounts to secure payment

●Addressed payments at risk

●Investigated missing invoices in received payments

●Monitored client communications

●Facilitated the receipt and storage of remittances

●Evaluated escalated accounts to determine subsequent steps in collection efforts

●Leveraged credit bureau data, postal service information, internet searches, and other tools to locate customers who moved or changed phone numbers

●Managed records of interactions and attempted communications with clients holding delinquent accounts, documenting any payments collected

●Addressed client issues and complaints related to billing

●Prepared regular reports detailing the status of unpaid accounts and repayment progress

●Established payment arrangements and initiated regular communication with insurance companies and payers to promptly resolve discrepancies in claim reimbursement

●Evaluated and processed claims that required payer requests for medical records, ensuring all necessary documentation was provided for timely claim resolution

●Analyzed, resolved, and identified trends in complex claims issues and payer behavior using the client billing system, payer portals, calling the payer, and reviewing Explanation of Benefits

●Monitored and identified frequent claim errors, reporting inaccurate contractual and reimbursement patterns when necessary

●Led follow-up activities while maintaining comprehensive records of correspondence and interactions with payers to track claim statuses and ensure timely resolution

●Orchestrated insurance benefits for claims across various insurance lines, enhancing communication with commercial insurers and insurance companies for benefit coordination and claim settlement

●Reached out to patients to rectify incomplete claims or incorrect member identification numbers, ensuring all necessary information was provided for claim processing

●Leveraged payer portals and communicated with patients and other payers to settle account balances and resolve billing discrepancies, including underpayments and overcharges Customer Service Representative, Remote

Acelara - February 2021 - January 2022

●Delivered outstanding customer service to over 70 clients by addressing inquiries, resolving issues, and offering detailed product and service information

●Leveraged Customer Relationship Management software to document customer interactions, track issues, and ensure timely follow-up, contributing to a streamlined customer service process

●Achieved a 95% customer satisfaction rating by delivering prompt and accurate responses, demonstrating empathy, and maintaining a professional demeanor in all interactions

●Mentored and trained new hires by providing guidance on call handling techniques and company policies, resulting in a 20% reduction in onboarding time and increased overall team efficiency

●Partnered with team members and supervisors to identify common customer issues, implement solutions, and enhance call center processes, resulting in a 15% decrease in average call handling time

●Engaged in regular training sessions to remain informed about new products, services, and best practices, ensuring the delivery of high-quality customer support

EDUCATION

Bachelor of Biomedical engineering computer science EDUCATION & CERTIFICATION

High School Diploma

SKILLS

●Claims Review ●Coordinating Documents ●Critical Thinking

●Revenue Cycle Management ●Claims Processing Proficiency ●Hospital billing/UB 04

●Multitasking Capabilities ●Writing report ●Customer Service

●Medicare ●Medicaid ●Time management

●Negotiation ●Open Accounts ●Denial Management

●Electronic Health Records ●Team Collaboration ●Effective Communication

●Insurance Verification ●Communication ●Medical Terminology

●PBM/ Prior authorization ●Attention to Detail ●Problem solving

●Skip tracing ●Data Entry ●Account Receivable (AR) ADDITIONAL DATA

●Microsoft Excel

●1: Excellent communication skills, both written and verbal, with a strong command of English

●2: Proven experience in delivering exceptional customer service and problem-solving

●3: Technical aptitude and familiarity with Apple products, services, and operating systems

●4: Ability to empathize with customers and adapt communication style to various customer profiles

●5: Strong multitasking skills and ability to work in a fast-paced environment

●6: Proficiency in using customer support tools and software

●7: Self-motivated with the discipline to work effectively in a remote setting

●8: Flexibility to work varying shifts, including weekends and holidays

●9: Consistently achieved high customer satisfaction ratings

●10: Experience in delivering exceptional customer service and problem-solving

●11: Strong multitasking skills and ability to work in a fast-paced environment

●12: Proficiency in using customer support tools and software

●13: Self-motivated with the discipline to work effectively in a remote setting

●14: Flexibility to work varying shifts, including weekends and holidays

Contact this candidate