Medical Billing Revenue Cycle

PROFESSIONAL SUMMARY

SKILLS

WORK HISTORY

KENISHA WALKER

Miami Gardens, FL 33055

786-***-**** - *********@*****.***

Effective Medical Claims Follow-Up Specialist with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.

ICD-10 Knowledge

Claims Processing Proficiency

HIPAA Compliance Understanding

Revenue Cycle Management

Denial Management Strategies

CPT Coding Familiarity

Commercial Insurance Policies

Medicaid and Medicare Knowledge

Electronic Claims

Billing and Collection Procedures

CMS-1500 Billing Forms

Insurance claims processing

06/2022 to 08/2023 Medical Billing Supervisor

NYU Langone Health – Boynton Beach, FL

Managed a team of medical billers, providing guidance and support for their professional development.

Led patient account reconciliations by identifying and rectifying discrepancies within patient accounts, ensuring accurate billing and collection processes. Improved efficiency in the medical billing process by streamlining workflows and implementing best practices.

Conducted regular audits to ensure compliance with federal, state, and industry guidelines.

Optimized organizational systems for payment collections, AP/AR, deposits, and recordkeeping.

03/2020 to 06/2022 Denials & Follow-Up Analyst

NYU Langone Health – Boynton Beach, FL

Improved claim resolution times by consistently following up on outstanding insurance claims and diligently addressing any discrepancies. Contributed to a reduction in aged accounts receivable by consistently tracking overdue balances and initiating appropriate collection efforts. Collaborated with insurance providers to expedite claims processing and secure timely payments for services rendered.

Communicated with insurance providers to resolve denied claims and resubmitted. Maintained up-to-date knowledge on payer guidelines and regulations, ensuring compliant claims submissions.

Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.

Expedited claims resolution by effectively collaborating with providers and payers to obtain necessary documentation or missing information. Enhanced claim processing efficiency by thoroughly reviewing and analyzing denial trends.

Identified patterns in payer denials, implementing corrective actions to prevent future occurrences.

Reduced collection time for outstanding invoices by closely monitoring aged accounts and maintaining frequent communication with insurance companies. 07/2018 to 01/2020 Medical Billing Specialist

Helix Healthcare Partners, LLC – West Palm Beach, FL Communicated with insurance providers to resolve denied claims and resubmitted. Posted and adjusted payments from insurance companies. Communicated effectively and extensively with other departments to resolve claims issues.

Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience. Located errors and promptly refiled rejected claims. Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable. Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.

Enhanced revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.

02/2018 to 07/2018 Revenue Cycle Specialist

Certified Foot And Ankle Specialists – West Palm Beach, FL Increased revenue by identifying and resolving billing errors in a timely manner. Ensured accurate billing with thorough audits of patient accounts and insurance claims.

Reached out to insurance companies to verify coverage and claim status. Communicated with insurance providers to resolve denied claims and resubmitted. Posted and adjusted payments from insurance companies. Communicated effectively and extensively with other departments to resolve claims issues.

Located errors and promptly refiled rejected claims. Made contact with insurance carriers to discuss policies and individual patient benefits.

11/2016 to 02/2018 Denials Coordinator

Conifer Health Solutions LLC – Boca Raton, FL

Safeguarded patient privacy by adhering to HIPAA guidelines when handling sensitive personal information during claim follow-up processes. Contributed to a reduction in aged accounts receivable by consistently tracking overdue balances and initiating appropriate collection efforts. Followed up on denied claims to verify timely patient payment and resolution. Responded to correspondence from insurance companies. Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.

Prepared insurance claim forms or related documents and reviewed for completeness.

Streamlined coordination between medical providers and insurance companies by serving as a reliable point of contact for all claim-related matters. 06/2014 to 10/2016 Appeals and Grievances Coordinator Prestige Health Choice – West Palm Beach, FL

Processed and finalized appeals and grievances within agreed-upon turnaround time.

Remained knowledgeable regarding company policies and procedures and current developments within operational departments.

Submitted verbal and written notification to members and providers. Actively participated in quality improvement initiatives aimed at enhancing the overall member experience within the organization''s healthcare services offerings. Demonstrated high-level attention to detail when reviewing medical records, provider contracts, and other relevant documents during case assessments. 05/2008 to 06/2014 Medical Insurance Coordinator

Dr. Rodney Young Pediatric Center – Miami, FL

Reduced claim denial rates by meticulously reviewing medical records and verifying the accuracy of billing codes before submission. Resolved claim disputes between healthcare providers and insurers swiftly through clear communication, thorough documentation review, and professional negotiation skills.

EDUCATION

Served as a liaison between patients, healthcare providers, and insurers, fostering positive relationships and open communication channels for all parties involved. Verified patient insurance coverage and benefits for medical claims. Monitored and updated claims status in claims processing system. Responded to correspondence from insurance companies. Followed up on denied claims to verify timely patient payment and resolution. Communicated effectively with staff, patients, and insurance companies by email and telephone.

Monitored changes in payer requirements, adjusting billing practices accordingly to minimize disruptions in the revenue cycle.

Located errors and promptly refiled rejected claims. Posted and adjusted payments from insurance companies. Communicated with insurance providers to resolve denied claims and resubmitted. 06/2001 High School Diploma

Miami Carol City Senior High School - Miami Gardens, FL

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