Ka'Ashka Nelson
Baton Rouge,LA
Summary
Revenue Cycle and claims professional with experience in claims processing, denials management, and accounts receivable.
AIC-certified with knowledge of insurance workflows, payer policies, and healthcare billing systems.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Revenue Cycle Specialist
Berkshire Hathaway
01.2023 - 02.2026
- Managed claims processing within the revenue cycle, ensuring accurate and timely claim submission and reimbursement
- Resolved denied and underpaid claims by identifying errors, correcting discrepancies, and supporting appeals
- Collaborated with billing, coding, and customer service teams to streamline reimbursement processes
- Improved claims accuracy and reduced rework by implementing quality control measures
- Monitored denial trends and contributed to process improvements that enhanced revenue cycle performance
- Addressed customer and provider inquiries related to claims status, billing issues, and payments
- Reduced claim rework and processing errors by approximately 20% through quality assurance and workflow improvements
Claims Intake Representative
Berkshire Hathaway
01.2021 - 01.2023
- Processed incoming claims efficiently, ensuring compliance with company guidelines and regulations.
- Reviewed documentation for accuracy, identifying discrepancies and facilitating resolution promptly.
- Utilized claims management systems to track and update claim statuses, enhancing workflow efficiency.
- Collaborated with cross-functional teams to streamline claims handling processes and improve turnaround times.
- Trained new representatives on system usage and best practices in claims intake procedures.
- Managed high volume of incoming calls, providing accurate claim information to clients and providers.
- Inputted detailed claim information into company databases, ensuring accuracy and easy retrieval for future reference.
- Delivered exceptional service under pressure while managing fluctuating call volumes during peak periods or natural disasters events.
Enrollment and Billing Specialist
UnitedHealth Group
Baton Rouge, LA
01.2018 - 12.2020
- Process enrollment applications, forms, or electronic submissions accurately and efficiently.
- Verify eligibility criteria based on program requirements, policies, or insurance plan guidelines.
- Communicate with applicants or clients to clarify information, request additional documentation, or provide enrollment status updates.
- Ensure all required documentation is complete and accurate before finalizing enrollment.
- Generate invoices, bills, or statements based on enrollment data, service usage, or insurance coverage.
- Calculate fees, premiums, or charges accurately according to established rates, contracts, or policies.
- Review billing discrepancies, resolve billing issues, and communicate with clients or stakeholders to address concerns.
- Process payments, refunds, adjustments, or credits accurately and promptly.
- Respond to inquiries from clients, customers, or members regarding enrollment status, billing inquiries, or payment options.
- Handle customer complaints or escalations related to enrollment or billing issues, ensuring timely resolution.
- Maintain accurate records of enrollment transactions, billing activities, and customer interactions.
- Update and maintain databases, spreadsheets, or electronic records with enrollment and billing information.
- Ensure data confidentiality and compliance with privacy regulations in handling sensitive information.
- Analyze billing trends, payment patterns, or enrollment data to identify opportunities for process improvement or efficiency.
Enrollment and Billing Specialist
Blue Cross Blue Shield of Louisiana
Baton Rouge, LA
01.2016 - 01.2018
- Processed enrollment updates, billing adjustments, and eligibility verification with high accuracy
- Resolved billing discrepancies and investigated claims issues to ensure proper reimbursement
- Handled high-volume customer inquiries related to billing, claims, and insurance coverage
- Reconciled accounts and corrected payment inconsistencies to maintain accurate financial records
- Ensured compliance with healthcare regulations, payer guidelines, and internal policies
- Reduced billing discrepancies and account errors by approximately 15% through detailed reconciliation and issue resolution
- Processed claims using advanced billing software to ensure accurate reimbursements.
- Collaborated with healthcare providers to verify patient information and improve billing accuracy.
- Led initiatives to streamline billing workflows, reducing turnaround time for processing claims.
Claims Specialist
Capital One
Baton Rouge, LA
08.2013 - 01.2016
- Receive, review, and process claims submitted by customers related to unauthorized transactions, fraud, errors, or disputes.
- Ensure all required documentation and information are collected and verified for each claim.
- Follow established procedures and guidelines to determine the validity and resolution of claims.
- Investigate and analyze the circumstances surrounding each claim, including reviewing transaction histories, account statements, and any relevant communication.
- Identify potential fraud patterns or suspicious activities and escalate as necessary for further investigation.
- Make informed decisions regarding the approval, denial, or escalation of claims based on findings from investigations and adherence to bank policies and regulatory requirements.
- Communicate claim decisions to customers, clients, or relevant stakeholders in a clear and professional manner.
- Provide assistance and support to customers or clients throughout the claims process, addressing inquiries, concerns, or requests for updates.
- Maintain a high level of customer service and professionalism when interacting with customers, ensuring their satisfaction and understanding of the claims resolution process.
Education
Bachelor of Science - Health Care Administration
Southern University And A&M College
Baton Rouge, LA01.2027
Skills
- Claims Adjudication
- Denials Management
- Appeals Processing
- Accounts Receivable (A/R) Management
- Insurance Verification & Eligibility
- Payer Policy Interpretation
- Claim Resolution
- Medical Billing Compliance
- HIPAA Compliance
- CD-10 Coding Knowledge
- CPT Coding Knowledge
- EHR/EMR Systems
- Payment Posting
- Audit & Quality Review
- Process Improvement
- Microsoft Excel (Data Analysis)
Accomplishments
- Reduced claim denial rate by 15–25% through improved insurance verification, accurate documentation review, and adherence to payer guidelines
- Processed and resolved an average of 120–180 claims per week while maintaining high accuracy and compliance with billing standards
- Completed Associate in Claims (AIC) certification, applying advanced knowledge of claims adjudication, denials management, and insurance policy interpretation in revenue cycle operations
Certification
- Associates In Claims Certification
- EHR/EMR System Training (Epic)
- HIPAA Compliance Training
Timeline
Revenue Cycle Specialist
Berkshire Hathaway
01.2023 - 02.2026
Claims Intake Representative
Berkshire Hathaway
01.2021 - 01.2023
Enrollment and Billing Specialist
UnitedHealth Group
01.2018 - 12.2020
Enrollment and Billing Specialist
Blue Cross Blue Shield of Louisiana
01.2016 - 01.2018
Claims Specialist
Capital One
08.2013 - 01.2016
Bachelor of Science - Health Care Administration
Southern University And A&M College
Awards
Employee of the Year, May 2025, for outstanding performance in claims processing accuracy, productivity, and quality standards.