Kandaze Kirkland
Norfolk,VA
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
9
9
years of professional experience
Work History
Claims Account Manager
TEKsystems
08.2024 - Current
- Review patient accounts to see if the credit on their account is a true credit.
- Use Nuxeo to send patients refunds for overpayments on their accounts.
- Follow up on claims that have been sent to a payer, with no updates.
- Collaborated with billing departments to proactively address potential credit balance discrepancies.
- Identified trends in provider/payer occurrences, and promptly resolved the issue.
- Investigate claim denials to ensure they are processed correctly.
- Verify patient coverage for the dates of service.
Medical Claims Adjuster
Sutherland Healthcare Solutions
06.2022 - 05.2024
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
Account Manager
Portfolio Recovery Associates
11.2017 - 04.2020
- Contacted customers to discuss late payments and options for remitting amounts due.
- Trained and mentored new employees on collection methods, documentation requirements and performance strategies.
- Researched accounts and completed due diligence to resolve collection problems.
- Contacted clients with past-due payments and actively monitored payments due from clients.
- Documented interactions in computer database and updated information.
- Followed prescribed scripts and maintained friendly but firm attitude with full knowledge of contractual requirements and legal remedies.
- Set up and updated customer accounts and CRM with interactions, payments and personal information.
Home Health Aide
Comfort Keepers Home Care
11.2015 - 10.2017
- Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
- Performed laundry, grocery shopping and other light housekeeping duties as instructed by client.
- Traveled to clients' homes to complete healthcare services and promote continuity of care.
- Provided mobility assistance such as walking and regular exercising.
- Completed entries in log books, journals, and care plans to accurately document and report patient progress.
- Followed nutritional plans to prepare optimal meals.
- Reported unusual or urgent circumstances in patients' condition or environment immediately to nurse supervisor.
- Monitored client health by performing routine pulse, temperature and blood pressure checks.
Education
GED -
Tampa Bay Tech High School
Tampa, FL06.2002
Skills
- Active Listening
- Medical Terminology
- Claims Investigations
- Time Management
- Microsoft Word
- Critical Thinking
- Skilled nursing
- Inpatient/Outpatient
- Medicare
- Medicaid
- Urgent care
- Navinet
- Experity
- Nasco
- TPX
- Waystar
- Tricare
Timeline
Claims Account Manager
TEKsystems
08.2024 - Current
Medical Claims Adjuster
Sutherland Healthcare Solutions
06.2022 - 05.2024
Account Manager
Portfolio Recovery Associates
11.2017 - 04.2020
Home Health Aide
Comfort Keepers Home Care
11.2015 - 10.2017
GED -
Tampa Bay Tech High School
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