Senior Healthcare Denial & Billing Expert (40+ Years)

ZEPHRIM L. KENNEDY, CRCS-I, CDRS

***** ******

Detroit, Michigan 48221

313-***-**** - home

313-***-**** - cell

Objective: To apply my 40 years of experience in Denial Management, Billing, Training and Client Services to

a challenging position offering professional growth

Skills: Extensive supervisory experience with knowledge of medical billing guidelines for procedure and

training purposes. Training clients and doing implementation of new billing systems. Ability to

establish and maintain effective work relationships with patients, employees and the public with

professionalism

Education: 6/1984 Highland Park Community College

Associate degree, General Studies

9/78 – 1/79 Detroit Shaw College, General Studies

6/1978 Detroit Mumford High School

Diploma, Major: College Preparatory

EMPLOYMENT

HISTORY:

11/2024 – 01/2026

Surgeons Choice Medical Center

SME-Claims Specialists

Submit Auto and Worker Comp claims for payment

Follow Up on Aged Claims (Multiple Insurances)

Work Escalations Reports/Duties assigned per management

Re-Assigned to working Medicare Advantage Aged Claims

4/19 – 11/2024

Ascension Medical Group

NRSC-Billing Representative – PBB

Review aged claims for resubmission to various payers

Submit Medicaid TPL forms for COB issues (Appeal Denied TPL Forms)

Monthly High Claim Review Status

12/17 – 2/2019

UST Global, Aliso Viejo, California

Sr. BPO Associate – Claims Processing

Process claims according to client guidelines

Linked supplier and provider to tax id and npi numbers for processing

Worked as an SME (Subject Matter Expert) to create process improvement for processing claim

11/16 – 12/17

Detroit Medical Center-Conifer, Detroit, Michigan

Denial Management Patient Accounting Representative Commercial Insurances

Alpha split A thru Z including worker comp and auto accident claims

Worked lockbox daily

Submitted appeals for timely filing claims

Assist with patient phone calls

6/15 – 11/16

Karmanos Cancer Institute, Detroit, Michigan

Patient Accounting Representative Commercial Insurances

Alpha split L thru Z including worker comp, auto accident and agency claims

Assist with patient phone calls

Work denied aged claims and letters from insurance company

Follow up on appeals submitted on denied claims

Follow up on international and hospice claims

3/11 – 6/15

Health Business Solutions, Detroit, Michigan

Lead Certified Denial Recovery Specialist Commercial Insurances

Analyze rejected claims for possible resubmissions

Mail patient letters for various reasons on rejected claims

Follow up on accounts that appeals have been submitted

Tasks – Coordinate medical record request, missing payment requests and insurance change requests

Works with staff of 4 denial recovery specialists

Verify provider contracting for in and out of network claims

6/03 – 3/11

Continuum Management Services, Dearborn, Michigan

Auditor/Training Dept. /Billing Dept/Web Access Administrator

Audit Billers and Statusers for accuracy

Web access for clients and staff

Train New employee on current billing system

Co-Externship coordinator

Create account manuals

Verify provider contracting for in and out of network claims

7/00 – 6/03

Detroit Medical Center, Orchestra Place, Detroit, Michigan

Lead, Patient Accounting Managed Care

Manage and supervise staff of nine

Train staff on new system upgrades

Monitor staff productivity

1/98-7/00

Detroit Medical Center, Orchestra Place, Detroit, Michigan

Patient Accounting Representative

Follow-up on aging accounts for 30 days and over

Analyze rejected accounts by insurance carriers

Submit appeals on accounts over 180 days old

7/96 – 1/98

SINAI HOSPITAL - CBO, Southfield, Michigan

Ambulatory Biller - Oakland Internist Associates

Follow-up biller for multi-specialty practice

Handle patient calls concerning bills and analyze accounts resubmit rejections

Specialties include cardiology, oncology, internal medicine and gastroenterology

2/95 - 7/96

DMC Health Care Centers, Livonia, Michigan

Lead, Medical Billing

Coordinate claims processing for all accepted insurance groups and contracts

Work directly with 15 employees

Distribute daily and weekly reports

Resolve rejections with various carriers

Monitor timecards and attendance records

Establish work priorities

4/93 - 1/95

Billing Clerk

Resubmit rejected claims for BCBSM

Submit audiology billing

UB-92 billings for BCBSM., BCN and Medicare expense registers

9/91 - 4/93

QCL Ltd., Detroit, Michigan

Medical Biller

Code BCBSM, Medicare, patient, commercial, physician and agency billings

Handle all patient and billing questions and incoming telephone calls

1/93 - 4/93

MBL, Inc., Flint, Michigan

Billing Consultant – Short Term Assignment/Referred by Federal Bankruptcy Trustee

Organize the billing department

Revise billing profiles, rebill rejections and adjust Medicaid claims

Restructure patient billing procedures

8/80 - 9/91

Quality Clinical Labs, Inc., Detroit, Michigan

Director of Medical Billing

Strong knowledge of various insurance company billing practices

Develop manuals to aid in training new employees

Monitor operation of IBM System 38, including processing computer tapes and running revenue reports

Resolution of problems and questions within the company

11/89 - 6/90

Household Retail Services, Inc., Birmingham, Michigan

Collection Department/Low-Level Delinquency

Call accounts that are 30-, 60-, 90- and 120-days delinquent

Update and verify account information and update payment arrangements

11/90 - 6/2005

Med-Quest Medical Management, Detroit, Michigan

Management Support Specialist/Consultant

Responsible for training new hires, front and back end

Responsible for submitting paper for system access for employees

Responsible for submitting physician’s paper work to payers

Responsible for helping staff understand payer contracts

Verify member enrollment in capitation agreement

Review fee schedules quarterly

1-/85 - 1/88

Downriver Medical Management Co.

Billing Consultant/Data Processor – Short Term Assignment/Referred by Med-Quest

Process billing and payment tapes on Control Data and Data General systems

Assist clients in resolving billing problems

Participate in training new employees and clients

Verify member enrollment in capitation agreement plan

9/86 - 4/87

Associated Medical Development Corp., Detroit, Michigan

Billing Consultant– Short Term Assignment/Referred by Med-Quest

Bill ultrasound and x-ray procedures to BCBSM, Medicaid and Medicare

Resolve patient billing problems

Resubmit rejected claims

1/85 - 6/86

Eastside Medical Laboratory, Inc., Detroit, Michigan

Billing Consultant – Short Term Assignment/Referred by Med-Quest

Assist in developing billing department procedures for laboratory billing

Interface with clients to resolve concerns

Train new and existing personnel on departmental operations

Professional

Experiences:

Billing procedures for independent laboratories seminars by Medicaid, Medicare and

BCBSM on a yearly basis

Operation procedures for IBM System 38

Completed CPC course

Advisory Board Member – Kaplan Institute of Detroit

Advisory Board Member – Everest Institute of Southfield

Advisory Board Member – Wayne County Community College

Citations:

8/2010 Certificate of Appreciation - Baker College Externship Program

6/2010 Certificate of Appreciation - Baker College Externship Program

8/2010 Letter of Recognition – Baker College Externs gaining employment

12/2008 Certificate of Recognition – Most Positive Person - Continuum Management Services

12/2013 Employee & Peer of the Year- Health Business Solutions

9/2013 Employee of the Month- Health Business Solutions

4/2013 Employee of the Month –Health Business Solutions

11/2011 Employee of the Month- Health Business Solutions

5/2007 Employee of the Month – Continuum Management Services

9/2004 Employee of the Month - Continuum Management Services

1/2009 Perfect Attendance Award – Continuum Management Services

1/2007 Perfect Attendance Award – Continuum Management Services

Certifications: Certified Revenue Cycle Specialist – Institutional 11/2013 to 11/2019

Certified Denial Recovery Specialists 8/2011 to 6/2021

Systems Used: SMS/Invision Health Quest Medicaid-CHAMPS

Signature ATHENA Medicare C-SNAP

Artivia NaviNet BCBSM Web-Denis

DaVinci EPremise Availity

CIGNA United Healthcare Noridian Medicare

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