Julia Kalafus
Summerville,SC
Summary
Results-driven Revenue Cycle and Healthcare Administration professional with over 10 years of experience in insurance verification, authorizations, revenue cycle operations, medical billing, internal auditing and accounts receivable. Skilled in resolving complex insurance claims, analyzing billing trends, and ensuring compliance while enhancing patient support throughout the healthcare process.
Overview
14
14
years of professional experience
Work History
Internal Auditor/ Account Receivable Specialist
Fresenius Medical Care
Remote, SC
01.2023 - Current
- Assist, develop and conduct monthly audits for the Revenue Cycle staff.
- Utilize established procedures to provide analytical and administrative support in compliance with company policies and procedures.
- Report data findings or trends to management.
Scheduling Specialist/Insurance Verification /Authorization
Ensemble Health Partners
Remote, SC
07.2021 - 12.2022
- Scheduled outpatient diagnostic services and inpatient direct admissions, ensuring accuracy and timeliness of requests.
- Verified demographic information with patients, confirmed insurance requirements, and collected co-pays or deposits to facilitate efficient patient processing.
- Verified the testing order was received and prepared for the patient's visit, checking medical necessity and discussing details with the physician's office.
Pre-services Representative
Roper St. Francis Healthcare
Ladson, SC
04.2019 - 07.2021
- Verified patient demographic information and collected co-pays or deposits to facilitate smooth check-in process.
- Verified testing orders for patient visits and coordinated with physician's office to confirm medical necessity.
- Scheduled outpatient diagnostic services and inpatient direct admissions, ensuring timely access to necessary care.
Medical Assistant
Carolina Pain Physicians
Ladson, SC
04.2016 - 04.2019
- Obtained patient vitals during appointments.
- Facilitated patient check-in and check-out processes to enhance overall patient experience and efficiency.
- Took patients back for appointments.
- Managed incoming and outgoing phone calls to ensure timely communication with patients and providers
- Contacted insurance providers for patient coverage verification. and receiving prior- authorizations for medications
- Verified insurance and medical records for patient eligibility.
- Assisted with procedures involving fluoroscopy or ultrasound.
Personal Banker
Wells Fargo
Moncks Corner, SC
01.2016 - 04.2016
- Consistently exceed loan volume goals for personal and car loans
- Knowledgeable of all bank products and services in order to educate clients, provide recommendations and create customized solutions that will accomplish their financial goals
- Scheduled 20+ face-to-face appointments weekly to strengthen client relationships and drive loan opportunities
- Followed up on referrals from inbound and outbound leads to convert prospects into clients
- Examined credit reports and communicated results to customers, aiding in informed financial decisions
Server
Logan's Roadhouse
Summerville, SC
01.2015 - 11.2016
- Built repeat customer base through commitment to exceptional service
- Memorized menu items to ensure customer satisfaction and meet expectations
- Addressed customer needs promptly
Shift Supervisor
CVS Pharmacy
North Charleston, SC
07.2012 - 12.2014
- Oversaw 6 employees per shift, including pharmacy staff, to ensure smooth operations.
- Trained and managed new cashiers on the CVS system
- Analyzed profit and loss statements to set daily operational goals.
- Secured safe with up to $10,000 in cash and valuables to ensure safety and compliance.
- Started as a cashier, managing a cash drawer of up to $2,500.
Education
Bachelor of Science - Criminal Justice, Psychology
Charleston Southern University
Charleston, SC12-2015
Skills
- CPT code expertise
- Medical billing expertise
- Claims processing
- Claim resolution
- Denial management
- Claims review
- Insurance verification
- Verifying insurance
- Payment posting
- Patient registration
- Accounts receivable management
- Billing software proficiency
- Billing systems knowledge
- Data analysis
- Data accuracy
- Quality assurance
- Audit compliance
- Auditing compliance
- Claims investigation
- Interpersonal communication
- Managing records
- Billing systems
- Auditing compliance
- Data accuracy
- Claims investigation
Timeline
Internal Auditor/ Account Receivable Specialist
Fresenius Medical Care
01.2023 - Current
Scheduling Specialist/Insurance Verification /Authorization
Ensemble Health Partners
07.2021 - 12.2022
Pre-services Representative
Roper St. Francis Healthcare
04.2019 - 07.2021
Medical Assistant
Carolina Pain Physicians
04.2016 - 04.2019
Personal Banker
Wells Fargo
01.2016 - 04.2016
Server
Logan's Roadhouse
01.2015 - 11.2016
Shift Supervisor
CVS Pharmacy
07.2012 - 12.2014
Bachelor of Science - Criminal Justice, Psychology
Charleston Southern University