Chantel Kearney
Angleton,TX
Summary
Seeking a challenging key support role in health care administration where my several years of experience will contribute to the success of the organization.
Overview
14
14
years of professional experience
Work History
Revenue Cycle Analyst
American Health Plans
05.2022 - 12.2022
- Responsible and accountable for revenue cycle performance in accordance with set goals and objectives. Responsible for quality work, meeting deadlines, and adherence to the Practices' Standard Operating Procedures (SOPs)
- Work as a remote revenue cycle specialist supports manager/supervisor in identification of potential lost revenue related to trends in charge entry, billing, coding, or contracting practices that are related to charge capture.
- Utilize standard coding guidelines and principles and coding clinics to verify that appropriate ICD-10 codes were assigned for accurate MS-DRG or APR-DRG assignment
- Produces and manages billing reports related to charges, payments, and denials, interprets data, and develops improvements.
- Generate aging reports, follow up on outstanding claims within a pre-defined time frame, and write appeal letters for denied claims.
- Ensured compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommended opportunities to strengthen internal control structure.
HEDIS Abstractor/Reviewer
Mindlance
02.2022 - 05.2022
- Responsible and accountable for HEDIS abstractor organizes patient records and identifies data within these files that are pertinent to HEDIS measures
- As a HEDIS abstractor, job duties include reviewing patient files, documenting diagnoses and treatments, and assign codes to the data that align with HEDIS domains of care
- Work as a remote contractor to review patient charts for certain criteria laid out by Cigna insurance companies
- Communicate effectively and professional with care provider offices, clinics, hospital, other clinical facilities
- Abide by all HIPPA and associated patient confidentiality requirements
- Conduct medical records abstractor, locate, and review all assigned medical charts, copy all supporting documentation per specifications and data enter into the applicable software system
- Created, maintain, and enter information into data bases
Appeals and Grievance Coordinator
Good Harbor Group
08.2021 - 03.2022
- Responsible and accountable for reviewing appeal and grievance ensuring compliance with company policies and contracts as well as State, Federal and Health Plan regulatory requirements for Medi-Cal lines of business
- Work as a remote appeals and grievance coordinator logging, tracking, and ensuring completion of all appeals and grievance cases in compliance with contract service standards
- Preparing and transmitting acknowledgement and final response letters in the format required by each contracted health plan
- Maintaining documentation associated with complaints, appeals and grievances to ensure responses are timely and in compliance with all applicable regulations and contracted timeframes
- Achieving a high level of workload volume, ensuring accuracy and compliance with scheduled deadlines
- Ensured compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure.
Appeals and Grievance Coordinator
Memorial Hermann
01.2016 - 10.2020
- Responsible and accountable for reviewing appeal and grievance ensuring compliance with company policies and contracts as well as State, Federal and Health Plan regulatory requirements for commercial lines of business
- Oversee and monitoring and review appeals and grievance concerns from members & provider
- Ensured that provider and member appeals were processed according to company health plans and policies
- Confirmed that all activities related to follow up functions meet department requirements, and levels of performance
- Provided analysis of the appeal and grievance
- Ensured compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure
- Interact daily with Customer Service Department, Medical Management Department, Medical Directors, Providers and Staff as necessary to effectively resolve appeals, complaints and quality of care or service issues
- Ensured that all legal, regulatory and policy requirements were met by keeping informed of changes and by implementing necessary controls and/or programs to meet requirements
Senior Appeal Rep
United Health Care
09.2011 - 06.2013
- Responsible and accountable for the supervision of claims auditing ensuring compliance with company policies and contracts as well as State, Federal and Health Plan regulatory requirements for commercial and senior lines of business
- Oversaw the monitoring and review of claim rep adjudication quality reports
- Ensured that provider and member appeals were processed according to company health plans and policies
- Confirmed that all activities related to follow up functions meet department requirements, maximized revenue collection, and achieved leading practice levels of performance
- Provided analysis of claim adjudication trends and identified training opportunities for claim reps
- Ensured compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure
- Demonstrated solid business, financial and program analysis capabilities including cost benefit analysis, cost effectiveness, economic and system evaluation skills
- Ensured that all legal, regulatory and policy requirements were met by keeping informed of changes and by implementing necessary controls and/or programs to meet requirements.
Senior Provider Service Rep
United Health Care
03.2009 - 09.2011
- Responsible for supporting various provider service functions with an emphasis on working externally with plan’s providers to educate, advocate and engage as valuable partners
- Served as resource expert regarding provider issues that may impact provider satisfaction
- Researched and resolved the most complex provider issues and appeals for prompt resolution
- Coordinated prompt claims resolution through direct contact with providers and claim department
- Researched, analyzed, and recommended resolution or provider disputes as well as issues with billing and other practices
- Acted as a liaison to ensure the relationship between contracted entities and health plan is at an optimal level of service
- Coordinated and monitored performance and quality improvement capacity building for network physicians and regularly reported on the status of efforts and impacts
- Led department projects and initiatives; performed targeted outreach as related to project deliverables and collaborated with internal departments to resolve provider network issues
- Consistently met established productivity, schedule adherence and quality standards
Education
Hurman Resource Mangement Certificate -
Houston Community College
Houston, TX05.2021
Medical Billing Certificate -
Ferndale Adult Education
Ferndale, MI06.1991
Skills
- Grievance Resolution
- Insurance Collaboration
- Medical Billing
- Claims Review
- Medical Terminology Knowledge
- Insurance Verification
- Insurance Benefits Understanding
- Medical Billing and Collections
- AR Aging Reports
- Denial Appeals Process
- Analytical and Critical Thinking
- Customer Service
Accomplishments
- Extensive knowledge of medical terminology across a broad range of medical practice areas
- Highly organized and independent; able to effectively coordinate tasks to accomplish projects with timeliness and creativity
- Strong understanding of ICD-10 CM and CPT requirements and procedures
- Proven ability to work creatively and analytically in a problem-solving environment.
Timeline
Revenue Cycle Analyst
American Health Plans
05.2022 - 12.2022
HEDIS Abstractor/Reviewer
Mindlance
02.2022 - 05.2022
Appeals and Grievance Coordinator
Good Harbor Group
08.2021 - 03.2022
Appeals and Grievance Coordinator
Memorial Hermann
01.2016 - 10.2020
Senior Appeal Rep
United Health Care
09.2011 - 06.2013
Senior Provider Service Rep
United Health Care
03.2009 - 09.2011
Hurman Resource Mangement Certificate -
Houston Community College
Medical Billing Certificate -
Ferndale Adult Education
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