Katherine Woods
Cottondale,AL
Summary
Detail-oriented and methodical Medical and Mental Health Billing offering [20 +] years of experience in related roles. Exceptional abilities in conducting research, problem-solving and prioritizing simultaneous tasks. Leverages resourcefulness, critical thinking skills and superior work ethic for top job performance.
Overview
25
25
years of professional experience
Work History
Credentialing, Revenue & Mental Health Billing Specialist
Billing Specialist Services, Inc
10.2021 - 05.2024
- Responsibilities Include; Credentialing providers for behavioral health services for all insurances (Illinois, Ohio, Iowa, Georgia, Alabama & Wisconsin)
- Eligibility and Benefit verifications
- Claims processing from EMR (Delphi, Simple Practice, Theranest & Therapy Appointment) to clearing house (Office Ally; Availity and claim MD)
- Working rejected claims through OA, A and CMD
- Working denied claims, performing corrected claims and performing appeals
- Posting Eras, paper checks and client payments
- Processing and posting of credit cards transactions from both client and insurance
- Working claim denials immediately from EOBs
- Provide communication to providers on claim issues, missing modifiers, and overall better practice guidance relation to insurance
- Collections
- Working aging and outstanding balance reports
- Prior authorizations as requested by providers and specific Pas for TMS procedures and any other PA as requested by providers
- Providing phone support for provider offices as requested
- Practice Set up for Group and Individual providers
- Creating and updating charge master
- Provide yearly training for providers on documentation guidelines per CMS
- Icd 10, CPT and HCPC yearly updates with any potential new add on codes and how to apply them appropriately for each insurance
- Training on proper modifiers for telehealth and place of service codes.
Medical Billing Customer Service Representative
Forefront Dermatology
05.2022 - 06.2023
- Responsibilities Include; Take 70-100 inbound-outbound calls calls per day
- Collect credit card payments
- Set up payment arrangements per company protocol
- Answer patient requests regarding billing issues, trouble shoot any billing related problems, resubmit claims, explains charges, adjustments accordingly and professionally
- Document all calls in detail related to each call
- Forward refund requests
- Effectively use multiple systems at one time
- Verify eligibility
- Ability to go the extra mile when needed.
MENTAL HEALTH WORKER Senior
BRYCE HOSPITAL
10.2020 - 01.2023
- Responsibilities Include; Accountability checks
- Performing ADL's as assigned or PRN
- Laundry duty for ADL's
- Feeding patients as needed
- Cleaning wheelchairs and walkers twice per week
- Obtaining vitals daily (temp / O2's)
- Reporting any patient issues to the floor supervisor
- Assist nurse during med pass.
SALES ASSOCIATE
SU BEAUTY SUPPLY LLC
01.2018 - 10.2020
- Responsibilities Include; Opening and closing store
- Stocking inventory
- Inventory Control
- Customer Service
- Maintaining knowledge of different product companies
- Ordering hair products.
REVENUE CYCLE CONSULTANT
COOPER GREEN MERCY HEALTH SERVICES
06.2017 - 12.2017
- Responsibilities Include; Six month contract
- Identify issues within the practice management software and EMR interface
- Updating charge master
- Reporting to the clinic manager and Board
- Physician credentialing
- Training clinical staff on simple billing procedures through the EMR
- Training billing departmental staff on proper billing procedures and how to troubleshoot claim issues
- Train staff on proper corrected claim process
- Training staff on software based billing guidelines
- Training staff on proper coding selection with EMR
- Contacting EMR vendor to update / remove edits for billing claims
- Performing revenue reports on demand for CEO
- Performing monthly and FY reports for CEO and Board
- Creating Clinic wide training manuals on proper billing procedures for clinical staff.
Revenue Cycle Manager
GREENE COUNTY HEALTH SYSTEM
09.2014 - 10.2017
- Responsibilities Include; Managed $13MM hospital revenue cycle budget of all insurance billing guidelines for Medicare, Medicaid, BlueCross Blue Shield of Alabama and all commercial insurance carriers for various departments
- Specialize in medical necessity with a 10 year history of knowledge and understanding of CMS/Medicare LCD's and NCD's
- Training of billing staff to department protocols
- Training staff on CPSI/Evident software when needed
- Training staff on medical necessity within CPSI software
- Training staff on pharmacy selection within CPSI software
- Training staff on lab ordering
- Training staff on AD-HOC reporting
- Training staff on software based on billed guidelines
- Training staff on proper coding selection within software
- Contacting Vendor to update/remove edits for billing claims
- Updating Charge Master as needed
- Performing revenue reports on demand for CEO
- Performing monthly and FY reports for CEO and board
- Completing Medicaid DSH reports yearly
- Participating entirely during yearly cost reports
- Involved in all revenue aspects related to hospital, clinic, nursing home and home health agency
- Participate in all contract negotiations
- Coding and/or oversight for all outpatient lab/radiology/IV hydration and IV infusion therapy due for medical necessity guidelines
- Perform all profession physician billing and/or oversight for physician billing within the revenue department
- Ongoing training to staff.
REGISTRATION MANAGER
GREENE COUNTY HEALTH SYSTEM
10.2014 - 09.2017
- Responsibilities Include; Trained over 100 staff members at all locations to ensure staff understands how to verify insurance, has basic knowledge of insurance and how to identify the difference is coverage based on primary and secondary coverage
- Ensure staff understands the difference between traditional Medicare and Medicare Advantage plans
- Training of staff for particular job protocols/job descriptions.
CREDENTIALING COORDINATOR
GREENE COUNTY HEALTH SYSTEM
10.2014 - 09.2017
- Responsibilities Include; Perform all credentialing for all locations; hospital, clinic, nursing home and home health agency to include each provider for each location
- Provide Medical staff with any appointment applications and/or renewal applications
- Update insurance contracts as needed
- Negotiate contracts as needed.
BUSINESS OFFICE ASSOCIATE
MULTI-TASKER
01.2013 - 10.2014
- Responsibilities Include; Maintaining knowledge of Medicare guidelines including CCI edits, maintaining knowledge of Blue Cross Blue Shield guidelines, Maintain knowledge of Medicaid guidelines as well as all Commercial Insurance guidelines
- Coding and keying all specialty clinic charges including; Endocrinology, Podiatry, Cardiology (Cardiology billing to include hospital rounds, caths, stents, and intervention surgeries) & Gastroenterology
- Coding and keying of any Internal Medicine charges as designated by supervisors for back up coverage
- Lead project coordinator for PQRS claim based reporting measurements for 15 of 28 SVMG providers
- Processing of daily electronic medical claims through vendor
- Processing electronic patient statements through vendor
- Downloading of daily reports including payer remittances, payer claims reports, statement reports
- Logging of daily reports and forward to appropriate processing rooms such as Medicare, Blue cross and commercial room
- Printing daily paper claims for processing
- Downloading Doctor score cards, drug reports, patient satisfaction & quality of care for entire practice of 28 providers
- Review, fax, log and follow up of provider preventative visit forms including Health Spring, Blue Cross Blue shield, Viva Health and UNITEDHEALTHCARE for incentive payments
- Processing and keying of insurance payments from all major insurances including Medicare, Blue cross and Medicaid
- Working monthly aging report to provide extensive and detailed follow up to ensure claims get processed and/or reprocessed for payment to include appeals if necessary
- Review all specialty clinic medical records before staff mails TO THE INSURANCE carrier
- ICD-10-CM training in office by designated professionals such as company AUDITORS and/or insurance companies such as United Healthcare
- Precertification and Authorization for Nuclear GXT stress test and all CT Scans performed at office location.
Patient Account Representative
SOUTHVIEW MEDICAL GROUP PC
09.2011 - 01.2013
- Responsibilities Include; Processing and keying of all Commercial Insurance payments
- Processing patient refund requests
- Processing insurance refund requests
- Submit corrected claims
- Submit claim appeals
- Submit redeterminations.
REVENUE CYCLE MANAGER & CREDENTIALING MANAGER
WTS
07.2004 - 11.2009
- Responsibilities Include; POSTING REMITTANCE ADVICE
- NEGOTIATE ALL INSURANCE CONTRACTS
- OVERSEE AR AND REPORT FINANCIALS TO CEO/RONNIE CHU MD
- MANAGE DEPARTMENT EMPLOYEES
- IMPLEMENT DEPARTMENTAL PROTOCOLS TO INCLUDE; BILLING, COLLECTIONS ETC
- MANAGE PAYMENT ARRANGEMENT PROTOCOLS
- PERFORM ALL CREDENTIALING FOR PRACTICE AND OTHER LOCATIONS
- CODING OF ALL CLINIC ENCOUNTERS FOR TWO LOCATIONS (DIAGNOSIS CODES)
- CODING OF ALL HOSPITAL ROUNDING TO INCLUDE DIAGNOSIS CODES AND CPT CODES
- TRANSCRIBING OFFICE NOTES WHEN THE TRANSCRIPTIONIST WAS BEHIND.
Director of Health Information Management
West Alabama Mental Health Center
11.2003 - 07.2004
- Responsibilities Include; CUSTODIAN OF MEDICAL RECORDS IN 5 COUNTIES IN 6 LOCATIONS
- SUPERVISION OF RECEPTIONISTS IN 6 LOCATIONS (9 RECEPTIONISTS IN TOTAL )
- RESPONSIBLE FOR PROVIDING ONGOING TRAINING TO STAFF REGARDING MENTAL HEALTH POLICY AND PROCEDURES
- CONDUCT WEEKLY CHART AUDITS FOR LOST REVENUE, PROPER CHART DOCUMENTATION , PROPER CHART FILING AND ETC
- CONDUCT WEEKLY APPOINTMENT AUDITS TO ENSURE RECEPTIONISTS SCHEDULED FOLLOW UP APPOINTMENTS ACCORDING TO THERAPIST REQUEST AND OTHER PROFESSIONAL STAFF REQUEST
- RESPONSIBLE FOR HIRING NEW STAFF AND TRAINING NEW STAFF
- REPORT ALL FINDINGS TO THE DIRECT SUPERVISOR CEO
- MEMBER OF AT LEAST THREE COMMITTEES WHILE EMPLOYED AT WHAM.
Director of Health Information Management
BIBB MEDICAL CENTER
09.1999 - 11.2001
- Responsibilities Include; CODING OF ALL INPATIENT , OUTPATIENT , SURGERY, ER'S, LAB AND X-RAY SERVICES
- IMPLEMENTING MEDICAL NECESSITY GUIDELINES FACILITY WIDE
- TRAINING STAFF ON MEDICAL NECESSITY GUIDELINES
- SUPERVISING DEPARTMENTAL EMPLOYEES
- CONDUCT MONTHLY MEDICAL STAFF MEETINGS/MINUTES AND MEDICAL STAFF APPOINTMENTS/ REAPPOINTMENTS
- CONDUCT MONTHLY UTILIZATION MEETINGS/MINUTES
- CONDUCT MONTHLY OR MEETINGS/MINUTES
- TRANSCRIBING OF H&P, D/C SUMMARY AND PROGRESS NOTES AS BACK UP
- PROVIDING MONTHLY REPORTS TO MEDICAL STAFF TO INCLUDE; ADMISSIONS, DISCHARGES, TRANSFERS, ER VISITS ETC.
Education
Did not obtain degree in Medical Coding and Billing -
Virginia College-Birmingham
Birmingham, AL01.2012
11th grade GED -
Demopolis High School
Demopolis, AL09.1994
Skills
- ICD Coding
- ICD-10 CODING
- CPT coding
- HCPCS
- Cost accounting
- Medicare
- Metadata
- Quality assurance
- SNF Billing
- Rural Healthcare Billing
- RUG Billing
- Swing Bed Billing
- Home Health Billing
- Inpatient Billing
- Outpatient Biliing
- Transcription
- Radiology Transcription
- Medical records
- Medical office management
- Medical Office Transcription
- Hospital experience
- Hospital Transcription
- EHS
- Blue Cross Blue Shield Billing
- Commercial Insurance Billing
- HIPAA
- EDI
- Accounts payable
- Medical Terminology
- Charge Master Review
- LTC pharmacy
- Microsoft Excel
- Microsoft Office
- Microsoft Word
- Microsoft Power Point
- Clinic Billing
- Physician Professional billing
- Surgery (Specialty) Billing
- Medical scheduling
- Accounts receivable
- Practice management
- EHR systems
- EMR systems
- Customer service
- Invoicing
- Workers' compensation
- Leadership
- Data entry
- Home health
- Health information management
- Medical Necessity
- Medical receptionist
- NPI
- Physician credentialing
- Hospital Credentialing
- Medicare HMO/Advantage plans
- Tricare Active Duty
- Tricare for Life
- Secondary claims
- Medical Coding
- Insurance Verification
- ICD-9
- Anatomy Knowledge
- Triage
- Negotiation
- Employee Orientation
- Management
- Supervising experience
- Financial management
- Business Requirements
- Collection management
- Bad Debt
- Administrative experience
- XML
- Time management
- Computer networking
- Medical office experience
- Documentation review
- English
- Employee evaluation
- Typing
- Behavioral health
- Medical billing
- ICD-10
- Communication skills
- Computer skills
- DRG
- Dermatology
- Cardiology Surgery Coding & Billing
- Gastroenterology Surgery Coding & Billing
- Billing systems and software
- HIPAA Compliance
- Denial Management
- Customer Engagement
- Claims Processing
- Claim submission
- Accounts receivable management
- Patient account management
- Invoice Processing
- Data entry proficiency
- Research and due diligence
- Collections
- Payment posting
- Invoicing proficiency
- Audit Procedures
- Procedure Development
- Month-end closing procedures
- Record preparation
- Contract Preparation
- Medical coding knowledge
- Fiscal reporting
- Collection practices
- Medical Billing Expertise
- Records organization and review
- Teamwork and Collaboration
- Vendor invoice processing
- Customer service support
- Customer Service
- Problem-Solving
- General accounting
- Problem-solving abilities
- Time Management
- Multitasking
- Multitasking Abilities
- Excellent Communication
- Organizational Skills
- Attention to Detail
- Billing Document Creation
- Error Revision
- Adaptability and Flexibility
- Self Motivation
- Time management abilities
- Decision-Making
- Team Collaboration
- Effective Communication
- Active Listening
- Customer Relations
- Problem-solving aptitude
- Reliability
- Charges and Rates Documentation
- Professionalism
- Interpersonal Skills
- Customer Contact
- Relationship Building
- General Ledger Entries
- Analytical Thinking
- Work Planning and Prioritization
- Collections processing
- Work Coordination
- Inventory Management
- Bank Statement Reconciliation
- Billing and Invoicing
- Analytical Skills
- Payment Processing
- Payment Transactions
- Payment Collection
- Financial statement analysis
- Interpersonal Communication
- Statement preparation
- Office Equipment Operation
- Continuous Improvement
- Dispute Negotiation
- Administrative Support
- Financial Transactions
- Invoicing prowess
- Management accounting
- Itemized Statement Preparation
- Correspondence
- Accounting Support
- Word Processing
- Database updates
Assessments
- Verbal communication, Proficient, March 2022, Speaking clearly, correctly, and concisely
- Customer focus & orientation, Proficient, May 2022, Responding to customer situations with sensitivity
- Nursing assistant skills, Proficient, January 2022, Providing nursing aid to patients using knowledge of relevant equipment and procedures
- Medical billing, Proficient, July 2024, Understanding the procedures and forms used for medical billing
- Bookkeeping, Proficient, January 2023, Calculating and determining the accuracy of financial data
- Attention to detail, Proficient, January 2023, Identifying differences in materials, following instructions, and detecting details among distracting information
- Protecting patient privacy, Proficient, January 2023, Understanding privacy rules and regulations associated with patient records
- Protecting patient privacy, Proficient, November 2022, Understanding privacy rules and regulations associated with patient records
- Office manager, Proficient, March 2021, Scheduling and budgeting
- Management & leadership skills: Impact & influence, Proficient, November 2023, Choosing the most effective strategy to inspire and influence others to meet business objectives
- Typing, Proficient, August 2024, Transcribing text
- Work style: Reliability, Proficient, May 2024, Tendency to be reliable, dependable, and act with integrity at work
- Spreadsheets with Microsoft Excel, Proficient, March 2021, Knowledge of various Microsoft Excel features, functions, and formulas
- Medical terminology, Proficient, July 2021, Understanding and using medical terminology
Timeline
Medical Billing Customer Service Representative
Forefront Dermatology
05.2022 - 06.2023
Credentialing, Revenue & Mental Health Billing Specialist
Billing Specialist Services, Inc
10.2021 - 05.2024
MENTAL HEALTH WORKER Senior
BRYCE HOSPITAL
10.2020 - 01.2023
SALES ASSOCIATE
SU BEAUTY SUPPLY LLC
01.2018 - 10.2020
REVENUE CYCLE CONSULTANT
COOPER GREEN MERCY HEALTH SERVICES
06.2017 - 12.2017
REGISTRATION MANAGER
GREENE COUNTY HEALTH SYSTEM
10.2014 - 09.2017
CREDENTIALING COORDINATOR
GREENE COUNTY HEALTH SYSTEM
10.2014 - 09.2017
Revenue Cycle Manager
GREENE COUNTY HEALTH SYSTEM
09.2014 - 10.2017
BUSINESS OFFICE ASSOCIATE
MULTI-TASKER
01.2013 - 10.2014
Patient Account Representative
SOUTHVIEW MEDICAL GROUP PC
09.2011 - 01.2013
REVENUE CYCLE MANAGER & CREDENTIALING MANAGER
WTS
07.2004 - 11.2009
Director of Health Information Management
West Alabama Mental Health Center
11.2003 - 07.2004
Director of Health Information Management
BIBB MEDICAL CENTER
09.1999 - 11.2001
Did not obtain degree in Medical Coding and Billing -
Virginia College-Birmingham
11th grade GED -
Demopolis High School
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