Kia Porter
Houston,TX
Summary
Diligent healthcare professional with 20 years of medical support and management experience.
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Goes above and beyond to manage priorities and problem-solve with quick turn-around expectation.
Overview
12
12
years of professional experience
Work History
Clinical Reviewer
Texas Oncology Cancer Center
05.2022 - Current
- Use medical and clinical review guidelines and parameters to maintain consistency in MD review process, appropriate utilization levels and compliance with facility policies and procedures.
- Utilize electronic medical record systems to store, retrieve and process patient data.
- Obtain patient's insurance information and determined eligibility for benefits for specific services rendered.
- Utilize knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Collect and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Review, analyze, and manage coding of diagnostic and treatment procedures contained in outpatient medical records.
- Reviewe outpatient records and interpreted documentation to identify diagnoses and procedures.
- Review patient charts to better understand health histories, diagnoses, and treatments.
- Review medical records for completeness and filed records in alphabetic and numeric order.
- Follow up with medical staff regarding missing information in patient records.
Healthcare Business Analyst
Methodist Hospital
11.2016 - 09.2023
- Developed dashboards with Tableau to monitor key performance indicators.
- Leveraged SQL queries to extract, transform and load data into databases.
- Translated raw data into meaningful information using statistical techniques.
- Reviewed healthcare data for accuracy and completeness to ensure compliance with applicable regulations and standards.
- Developed detailed project plans and timelines for assigned projects in support of organizational goals.
- Collaborated with stakeholders across departments to develop requirements documents and technical specifications.
- Created process maps, flowcharts and diagrams to document workflow processes related to healthcare operations.
Senior Claims Analyst
Nightlight Pediatric
10.2018 - 03.2020
- Reviewed, researched and evaluated customer claims to determine coverage under policy provisions or applicable laws.
- Interpreted insurance policies, endorsements and riders to identify coverage limits and exclusions.
- Resolved complex claim issues by examining evidence, analyzing legal documents, and conducting investigations.
- Investigated fraud cases by obtaining relevant information from various sources including law enforcement agencies.
- Ensured proper documentation was maintained according to established procedures.
Claims Resolution Specialist
UT Physicians
05.2015 - 11.2016
- Provided guidance and advice regarding policies and procedures for filing a claim.
- Collaborated with other departments to obtain additional information needed for claim resolution.
- Prepared detailed reports summarizing all activities pertaining to each claim.
- Ensured compliance with applicable laws, regulations, policies and procedures when processing claims.
- Assessed potential fraud cases by conducting investigations into suspicious activity.
- Negotiated settlements between claimants and insurance companies in order to reach an agreement.
System Analyst
Memorial Hermann Hospital
03.2013 - 05.2015
- Developed system requirements documents and analyzed user needs to ensure the delivery of quality software solutions.
- Identified opportunities for process improvement by analyzing existing systems, processes, and feedback.
- Analyzed patient data to ensure accuracy of medical records.
- Reviewed medical records for completeness, accuracy, and compliance with regulations.
- Maintained detailed documentation related to all aspects of patient care.
- Monitored billing activities to ensure timely submission of claims forms.
Education
Bachelor Of Science - Social Work
University of Texas At Arlington
Arlington, TX08-2024
Worthing High School
Houston, TX05.1996
Skills
- Problem-Solving
- Decision-Making
- Attention to Detail
- MS Office
- Prior Authorization Processing
- Medical Terminology
- CPT Coding
- Computer Proficiency
- Teamwork and Collaboration
- Organization and Time Management
- Data Entry Software
- Health Data Management
- Process Mapping
- Project Management
- Data Validation
- Technical Analysis
- Database Programming and SQL
- Tableau
- Revenue Cycle Management
Timeline
Clinical Reviewer
Texas Oncology Cancer Center
05.2022 - Current
Senior Claims Analyst
Nightlight Pediatric
10.2018 - 03.2020
Healthcare Business Analyst
Methodist Hospital
11.2016 - 09.2023
Claims Resolution Specialist
UT Physicians
05.2015 - 11.2016
System Analyst
Memorial Hermann Hospital
03.2013 - 05.2015
Bachelor Of Science - Social Work
University of Texas At Arlington
Worthing High School