DALHAT KADIRI
Garland,TX
Summary
Results-driven professional with over 6 years of experience in revenue cycle management, insurance follow-up, accounts receivable (AR) follow-up, and customer service. Skilled in claims processing, denial resolution, patient billing, and insurance verification. Adept at collaborating with cross-functional teams, managing high-volume accounts, and ensuring accurate reimbursements while maintaining exceptional customer service and compliance with HIPAA regulations.
Overview
6
6
years of professional experience
Work History
Revenue Cycle Specialist
CHECKLOS
Remote
12.2023 - 02.2024
- Efficiently resolved claims by completing necessary appeals and forwarding materials/accounts to payers for processing.
- Tracked claim status, investigated rejections and denials, and documented all account activities for accurate records.
- Identified potential issues with claims and collections, implementing solutions to improve reimbursement accuracy.
- Reviewed and interpreted EOBs to determine denial reasons, including CPT code-specific discrepancies, and initiated appropriate resolutions.
- Reviewed patient balances for accuracy and followed up with patients for payment collection.
- Investigated underpayment denials from payers and implemented corrective actions to secure proper reimbursement.
- Utilized payer portals to understand denial reasons and applied suitable resolutions to ensure accurate payment.
- Followed up on payments from both commercial and government payers through calls, emails, and portal communications.
- Took necessary actions on claims, including sending appeals, responding to medical record requests, and researching resolutions for denied claims.
- Maintained precise documentation for all accounts and addressed correspondence to resolve outstanding claims.
- Managed a high volume of claims daily while prioritizing high-value balances and work queues.
- Contacted responsible parties to secure payment for outstanding invoices and ensured collection of all assigned division balances.
- Accurately posted payments according to received EOBs to maintain account integrity.
- Served as a resource for staff inquiries regarding billing or reimbursement issues, providing guidance on complex cases.
AR Follow up Representative
DF GATES BILLINGS
Dallas, TX(Remote)
05.2021 - 10.2023
- Contacted patients regarding pending balances, including copays, coinsurance, and deductibles, ensuring timely collection and resolution.
- Responded to written correspondence from payers and patients, addressing questions and resolving issues efficiently.
- Facilitated resolution of claims issues, including incorrectly paid claims, by collaborating with operational teams and provider billing departments while analyzing system data.
- Managed claims across all aging buckets, including posting, appeals, and reconciliation.
- Identified and resolved payment discrepancies between patients and providers to ensure accurate account balances.
- Followed up with payers via phone, email, fax, or online portals to ensure timely resolution of outstanding claims.
- Contacted responsible parties for past-due debts and maintained accurate records of communications.
- Reported appeals with strong supporting documentation to supervisors for escalation to payer level.
- Researched missing payments and obtained necessary documentation for accurate posting and claim resolution.
Insurance Follow-Up Representative
MONFRONT BILLINGS
Dallas, TX(Hybrid)
04.2019 - 03.2021
- Communicated daily with commercial and government payers to resolve discrepancies and secure accurate reimbursement on claims.
- Reviewed claims requiring medical record requests and coordinated submissions to payers for processing.
- Tracked common claim errors, identified underpayments or overpayments, and reported inaccurate reimbursement and contractual trends.
- Performed follow-up actions on unresolved claims, documenting all activities and communications with payers.
- Utilized phone outreach and payer portals to check claim status and investigate reasons for non-payment.
- Took appropriate actions to resolve issues, resulting in payment receipt and full closure of insurance balances.
- Analyzed root causes of claim discrepancies, reviewing and resolving complex claims using client billing systems, payer portals, EOBs, and direct communication with payers.
- Maintained accurate documentation on claim status, ensuring proper resolution and reimbursement.
Customer Service Representative
EVOLVE HEALTHCARE
Dallas, TX
05.2018 - 03.2019
- Responded to customer inquiries and suggestions courteously and professionally, ensuring high satisfaction.
- Actively listened to customer concerns, resolved issues promptly, and escalated complex matters to supervisors when necessary.
- Verified customer insurance eligibility and coverage to support accurate claim processing.
- Managed a high volume of inbound calls with minimal wait times while maintaining quality service.
- Provided product and service information, identifying opportunities to enhance member and provider experiences.
- Collaborated with team members and internal departments to determine appropriate resolution of issues.
- Tracked customer service cases and maintained accurate records in service software/CRM systems.
Education
Bachelor of Science -
University of Massachusetts
Amherst05.2021
Skills
- Customer Service & Relations
- Active Listening & Empathetic Communication
- Call Center Operations & Complaint Handling
- Problem-Solving & Critical Thinking
- Team Collaboration & Cross-Functional Coordination
- Adaptability & Flexibility in Fast-Paced Environments
- Health Insurance Verification & Eligibility Checks
- Medical Claims Processing & Billing Support
- Patient Scheduling, Registration & Appointment Coordination
- Explanation of Benefits (EOB) & Prior Authorizations
- Knowledge of Medicare, Medicaid, HMO, and PPO Plans
- HIPAA Compliance & Patient Confidentiality
- CRM Systems: Salesforce, Zendesk, ServiceNow, HubSpot
- Electronic Health Records (EHR): Epic, Cerner, Athenahealth, Availity
- Data Entry & Documentation Accuracy
- Microsoft Office Suite: Excel, Word, Outlook
Timeline
Revenue Cycle Specialist
CHECKLOS
12.2023 - 02.2024
AR Follow up Representative
DF GATES BILLINGS
05.2021 - 10.2023
Insurance Follow-Up Representative
MONFRONT BILLINGS
04.2019 - 03.2021
Customer Service Representative
EVOLVE HEALTHCARE
05.2018 - 03.2019
Bachelor of Science -
University of Massachusetts