Summary
Overview
Work History
Education
Skills Expertise
Timeline
Generic

Kimberly Nguyen

Fort Worth,TX

Summary

Highly skilled and detail-oriented analyst that has over 10 years of excellent customer service and experience in healthcare revenue cycle management. Currently looking for a challenging position where I can utilize my expertise in analyzing and resolving insurance denials to improve financial outcomes.

Overview

11
11
years of professional experience

Work History

Dispute Resolution Reviewer I

TMF Health Quality Institute/C2C Innovative
04.2024 - Current
  • Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
  • Performs complex (journey-level) work.
  • Provides dissatisfied beneficiaries and/or providers an independent second level determination based on the documentation, facts, laws, regulations, and guidelines.
  • Reviews medical records/case file and writes a decision based off of federal regulations and that supports the determination made, and documents provided.
  • Responds to and ensure that all issues raised by the beneficiary, representative, supplier, and provider have been addressed.

High Dollar Review/PTAC Unit Rep

PARALLON
01.2022 - 04.2024
  • Oversee high dollar accounts to ensure that the correct insurance was set up and eligibility was verified
  • Ensure the correct coordination of benefit and insurance plan type was entered prior to billing
  • Email appropriate departments to make correction or obtain missing information required for billing and verifying insurance
  • Track and inform management of trends that could negatively impact financial outcomes

PreBill Denial Analyst

PARALLON
09.2013 - 01.2022
  • Received Parallon's Elite Employee Award for being the top performer
  • Review and analyze denied authorization to identify root causes and trends
  • Conduct thorough research to determine whether medical necessity or technical denials can be overturned or if an appeal will need to submitted
  • Prepare documentations and fax confirmation in response to authorization and medical necessity denial
  • Track denial trends to escalate to leadership
  • Exceeded departments weekly quota of 100%.

Education

Bachelor of General Studies - Health Studies and Business

TEXAS WOMAN's UNIVERSITY
Denton, TX

Skills Expertise

  • Reviewing medical insurance denials and policies
  • Insurance authorization and verification
  • Meditech
  • Midas
  • Excel
  • EOB, claims, policies and documentation review

Timeline

Dispute Resolution Reviewer I

TMF Health Quality Institute/C2C Innovative
04.2024 - Current

High Dollar Review/PTAC Unit Rep

PARALLON
01.2022 - 04.2024

PreBill Denial Analyst

PARALLON
09.2013 - 01.2022

Bachelor of General Studies - Health Studies and Business

TEXAS WOMAN's UNIVERSITY

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Kimberly Nguyen