Julie Kinney
Westville,IL
Summary
An organized and motivated individual, eager to utilize time management and organizational skills across diverse settings. Seeking entry-level opportunities to enhance abilities while contributing to company growth.
Overview
38
38
years of professional experience
Work History
Claims Analyst
Health Alliance
Urbana, United States
10.2013 - Current
- As a Claims Analyst my duties include, accurately processing medical, dental, orthodontia and pharmacy claims for timely payment to providers and members
- Interpret and apply a wide variety of provider reimbursement methodologies, benefit plan designs, employer/member contracts and Medicare and Medicaid pricing methodologies
- Required knowledge of Explanation of Benefits, healthcare coding requirements (ICD-9, ICD10, CPT, CDT, HCPCS) and legislation, and claim billing forms (CMS1500, UB04, dental claim form, as well as electronic billing formats)
- Medical claims adjudication and healthcare billing
- Organize, prioritize and remain flexible in order to meet turnaround times and performance guarantees
- Supervisor: Jason Edenburn (217-902-8387)
- Okay to contact this Supervisor: Yes
Workers' Compensation Claims Adjuster
CCMSI
Danville, United States
09.2008 - 10.2013
- The investigation and evaluation of workers' compensation claims and handle lost-time cases
- Determine compensability of claim or if any third party involvement exists
- Prioritize claims for completion and follow up
- Requested signed ROI (release of information) from Injured worker to obtain medical records
- Reviewed medical records to determine diagnosis matched the work injury
- Responsible for analyzing medical record data for current clinical classification systems appropriate for type of care provided to injured worker
- Examining medical bills for correct coding which included assignment of ICD codes for diagnosis and procedures
- Reviewed claims for abstract and sequence codes to ensure correct diagnosis of related group
- Communicate with injured employees, medical staff, or legal to ensure understanding and awareness of process, requirements, and entitlements
- Follow up with treating physicians for status checks
- Receive subpoenas and forwarded to assigned legal counsel
- Proper and accurate follow up on pending issues
- Authorize payments of medical, TTD, and PPD
- Compute disability rates when appropriate
- Prioritize and coordinate work to complete duties within the required timeframe
- Managed claimants files, both paper and electronic maintaining organization to ensure claims were handled properly
- Used CCMSI's computerized patient records system
- Identified claims files by using protected health information in order to resolve any disputed claims
- Supervisor: Sarah Richardson (217-260-7505)
- Okay to contact this Supervisor: Yes
Insurance Billing/Patient Accounts
Sreeman Prathipati, MD
Danville, United States
07.1998 - 09.2008
- Patient data entry, set-up insurance claim forms and electronically file the insurance claims
- Performing analytical duties to ensure timely processing of insurance claims in order to maximize reimbursement
- Maximizing reimbursement of insurance claims by proper coding guidelines
- Assign codes using clinical classification systems appropriate for the type of care provided for physical therapy for billing as well as outpatient coding for CPT codes for surgeries, procedures and evaluation and management services and equipment
- Outpatient coding including assignment of ICD codes for diagnosis for physical therapy, surgery, and procedures
- Receive payments for processed claims, apply payments to patient accounts, bill the patients for remainder amount and resolve patient accounts
- Send medical records and signed forms on behalf of the patients
- Efficient with online program and software as well as acquainted with several billing software programs
- Knowledge of HIPPA guidelines
Store Manager
Gery & Al's Sporting Goods
Danville, United States
08.1987 - 06.1998
- Retail sales experience
- Maintained a high level of customer service
- Supervised overall daily operations of store, scheduling and supervision of 25 employees
- Maintained financial accounts and bank deposits
- Inventory control
- Supervisor: Paul Marana (2172137560)
- Okay to contact this Supervisor: Yes
Education
Technical or occupational certificate - Medical Office
Danville Area Community College
Danville, IL, United States06-2001
Skills
- Communication skills
- Organizational skills
- Data entry
- Customer service
Affiliations
Cornerstone Christian Church - member
Languages
English, Advanced, Advanced, Advanced
References
- Danielle Watson, VA Healthcare, HR, 217-274-3057
- Paulina Dyson, Health Alliance, State of Illinois Team Lead, 217-902-8346, Paulina.Dyson@healthalliance.org
- Pearl Hough, Health Alliance, Claims analyst, 217-377-7801, pearl.hough@healthalliance.org
Availability
Permanent, Full-time
Mobile Numbers
- 217-274-3407
- 217-274-3577
Relevant Coursework Licenses Certifications
Medical Office Certificate
Timeline
Claims Analyst
Health Alliance
10.2013 - Current
Workers' Compensation Claims Adjuster
CCMSI
09.2008 - 10.2013
Insurance Billing/Patient Accounts
Sreeman Prathipati, MD
07.1998 - 09.2008
Store Manager
Gery & Al's Sporting Goods
08.1987 - 06.1998
Technical or occupational certificate - Medical Office
Danville Area Community College
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