Aundrea Newkirk
Greensboro,NC
Summary
Experienced healthcare professional with strong background in processing and managing medical claims. Skilled in analyzing complex data, ensuring compliance with regulations, and resolving claims efficiently. Known for collaborative approach and adaptability, consistently delivering results in dynamic environment. Reliable team player with expertise in medical billing software, HIPAA regulations, and customer service.
Overview
14
14
years of professional experience
Work History
Medical Claims Specialist
Blue Cross and Blue Shield of NC
REMOTE
07.2023 - 01.2025
- Examine submitted claims from healthcare providers to ensure that they are complete and comply with the insurance policy terms.
- Assesses whether the claims are valid and if the services provided are covered under the insured's policy.
- Calculate using DRG & APC calculations to determine the amount insurance will pay for the claims and also determine the patients financial responsibility through OPPS and IPPS systems.
- Communicate decisions to healthcare providers and policyholders, also explaining any denials and or adjustments, maintaining the ability to work with both parties to resolve issues and ensure the proper outcome.
- Maintaining detailed records of claims, payments, and correspondence for future reference and audits, overall ensuring te claim process runs smoothly and both parties are treated fairly.
Medical Billing and Collections Specialist
UnitedHealth Group
08.2021 - 06.2023
- Prepare and submit claims to insurance companies and government programs for reimbursement of services provided by healthcare professionals.
- Follows up on unpaid claims and outstanding balances, working to collect payments from patients and insurance companies.
- Verify patient insurance information and coverage to ensure that claims are processed correctly and efficiently, investigate denials and discrepancies resolve disputes, and appeal claims when necessary.
- Communicate with patients regarding their bills, payment plans, and any questions or concerns they may have about their accounts. Ensuring compliance with healthcare regulations and billing practices is essential to avoid legal issues.
Patient Intake Specialist
Advanced Home Care Inc.
High Point, NC
02.2018 - 06.2021
- Entered referrals while communicating with referral source, physician, or associated staff to ensure documentation is routed to the appropriate physician for signature/completion
- Communicated financial responsibility to patients
- Collected payments while navigating through multiple EMR systems to obtain proper documentation
- Coded and abstracted medical records according to ICD-10-CM and CPT coding guidelines
Claims Representative
LabCorp
McLeansville, NC
12.2016 - 02.2018
- Review and process insurance claims submitted for laboratory services, ensuring accuracy and completeness.
- Communicate with healthcare providers, patients and insurance companies to resolve any issues related to claims, including denials or discrepancies
- Follows up on outstanding claims to ensure timely payment, addressing and delays or issues that may arise.
- Handle disputes and appeals related to denied claims, working to resolve issues and secure appropriate reimbursement.
Technical Support Representative
Spectrum
Greensboro, NC
12.2010 - 02.2017
- Assisted customers in identifying issues and explained solutions to restore service and functionality
- Documented support interactions for future reference
- Used ticketing systems to manage and process support actions and requests
- Resolved a diverse range of technical issues across multiple systems and applications for customers and end-users across various time zones
Education
High School Diploma -
Ben L. Smith High School
Greensboro, NC06.2010
Skills
- Knowledge of Medical Terminology
- ICD and CPT experience
- Attention to detail
- Analytical and problem solving skills
- Advanced Microsoft Office Knowledge
- Communication skills
- HIPAA Compliance
- EMR Systems trained
Timeline
Medical Claims Specialist
Blue Cross and Blue Shield of NC
07.2023 - 01.2025
Medical Billing and Collections Specialist
UnitedHealth Group
08.2021 - 06.2023
Patient Intake Specialist
Advanced Home Care Inc.
02.2018 - 06.2021
Claims Representative
LabCorp
12.2016 - 02.2018
Technical Support Representative
Spectrum
12.2010 - 02.2017
High School Diploma -
Ben L. Smith High School