Kandie M. Lopez
Killeen
Summary
Experienced A/R Revenue Recovery Team Lead with a strong background in insurance billing, claim denials, and medical terminology across outpatient and inpatient setting. Proven ability to lead teams, improve productivity, and resolve complex claims efficiently. Seeking a supervisory role where I can leverage my leadership skills, mentor team members, and contribute to operational excellence and revenue recovery performance.
Overview
10
10
years of professional experience
Work History
Team Lead
R1
01.2023 - Current
- Review and apply client contract language and rates as necessary to resolve denied claims.
- Utilize payer provider manuals to dispute denied claims
- Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
- Lead a team with 10 + analyst
- Analyzed performance metrics to identify areas for improvement and drive team accountability.
- Fostered a collaborative work environment through effective communication and team-building activities.
- Review EOBs and provider systems to obtain payment information and apply the proper payments to accounts for billing.
- Report on KPIs for multiple clients
- Trained and mentored new employees in workflow processes and best practices for efficiency.
- Create assignment for multiple teams to remain within metric
Analyst II
Cloudmed R1
01.2021 - 01.2023
- Draft appeals and letters to insurance companies.
- Follow up on denied claims, appeals and or any submission submitted to payers.
- Establish regular reporting requirements to review progress and mitigate potential issues, discuss recommendations and findings.
- Calculate claims expected reimbursement using payer contracts and provider manuals.
- Mentor new hires.
- Conduct investigations to discover the reason for unpaid or underpaid claims or reimbursements.
- Close account back to client once claim is paid in full.
- Verify records and documentation and ensure that all required paperwork and supporting materials have been submitted properly.
- Define and implement key activities that enhance continuous organizational preparedness and recovery.
Medical Biller/Coder
BoozmanHof Eye Clinic & Surgery Center
01.2018 - 01.2021
- Assigns appropriate CPT-4 procedure code(s) to accurately report the physician services provided to patients.
- Assigns appropriate ICD-9 diagnosis code(s) to accurately support the need for each physician service.
- Check out all patients by verifying information and collecting co- payments.
- Making and confirming appointments over the phone and in person.
- Triaging patients concerns.
- Entering insurance charges for patients.
- Coding exams.
- Scrubbing claims to ensure proper payment.
- Collecting balances.
- Answering billing questions for patients.
- Compulink software user expert.
- Train new hires.
Medical Biller/Coding
Common Compounds Inc
01.2016 - 01.2018
- Actively follow up and collect on all paper and electronic claims, including resolution of any billing errors assigned following established procedures.
- Respond to correspondence from insurance carriers or defense attorneys to facilitate payment.
- Follow-up on unpaid/underpaid claims. Creating appeals ensuring that all appeals processes are followed to obtaining full reimbursement.
- Submit EDI claims and work clearinghouse rejection reports.
- Review CPT, ICD-10, and modifier coding for accuracy.
- Post insurance and guest payments; perform necessary adjustments.
- Review payment denials and claim rejections; research and resubmit within established time frames.
- Process electronic EOBs.
- Trained clinics/ new hires
- Workers’ Compensation - Dispensing in office for the state of TX, CA, MD, LA, MS, and FL.
Logistics Director
Ez Pharma Rx
01.2016 - 01.2018
- Coordinating inventory, transportation, and delivery of products.
- Liaising and negotiating with suppliers, pharmaceutical manufacturers, retailers and consumers.
- Comply with laws, regulations and ISO requirements.
Pharmacy Tech T.
American Specialty Pharmacy
01.2016 - 01.2016
- Maintained records by recording and filing physicians' orders and prescriptions.
- Organized medications for pharmacists to dispense by reading medication orders and prescriptions; preparing labels; calculating quantities; assembling intravenous solutions and other pharmaceutical therapies.
- Dispensing with accuracy.
Education
Coding Specialist - Medical Billing
Southern Careers Institute
Harlingen, TX01.2011
Skills
- Proficient in medical language
- MD Office, MD Scripts, and Rx billing specialist
- Workers’ compensation expertise
- Experience with IP and OP accounts receivable denials
- EPIC portal proficiency
- Software QA expertise
- Proficient in Power BI
- Team leadership for 10 analysts
- Precise data entry
- In-depth understanding of health insurance billing
- Microsoft Office certification: Word, Excel, PowerPoint
- Assessment of visual functions
- Strong analytical and problem-solving skills
- Independent project management
Languages
Spanish
Timeline
Team Lead
R1
01.2023 - Current
Analyst II
Cloudmed R1
01.2021 - 01.2023
Medical Biller/Coder
BoozmanHof Eye Clinic & Surgery Center
01.2018 - 01.2021
Medical Biller/Coding
Common Compounds Inc
01.2016 - 01.2018
Logistics Director
Ez Pharma Rx
01.2016 - 01.2018
Pharmacy Tech T.
American Specialty Pharmacy
01.2016 - 01.2016
Coding Specialist - Medical Billing
Southern Careers Institute
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