Karen Richmond
Schaumburg,IL
Summary
Accomplished medical professional with over 26 years of experience, demonstrating unwavering loyalty, focus, and drive within the healthcare sector. Expertise in effective communication and collaboration fosters strong team dynamics while providing executive support and leadership to enhance business operations. Recognized for motivating colleagues and managing multiple tasks and priorities, ensuring seamless project execution aligned with company objectives. Committed to contributing to an environment that values open communication and innovative thinking, with a strong desire to leverage skills in a rewarding medical assistant role that promotes growth and performance excellence.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Reconciliation Specialist
Concentra-Lombard, IL
09.2022 - Current
- Compare and verify data from various sources, such as claim systems, payroll, and insurance providers.
- Identify and resolve discrepancies in claim data, payment amounts, and other relevant information.
- Investigate the root causes of discrepancies and ensure accurate claim processing.
- Research and gather information to support claims, investigations, and resolutions.
- Ensure compliance with workers' compensation laws, regulations, and internal policies.
- Maintain accurate records and documentation related to workers' compensation claims.
- Communicate with employees, supervisors, HR, Payroll, and insurance providers regarding workers' compensation matters.
- Collaborate with other departments to ensure smooth claim processing and timely payments.
- Assist with the preparation of reports and analysis related to workers' compensation claims.
- Development and implementation of workers' compensation policies and procedures.
Benefit Review Specialist
Option One Capital-Fremont, CA
10.2019 - 01.2020
- Applied and Adhered to HIPAA Privacy and Security Regulations
- Performed, conducted data accurately, and researching to resolve questionary issues, and maintain the data accurately in the database
- Performed insurance verification, including eligibility, pre-certification and pre-authorization, for patient visits and/or procedures
- Obtain insurance authorizations for proper billing codes
- Process patient insurance claims to their designated insurance carriers
- Experience with most commercial plans and government plans.
- Effectively coordinated all communications between patients
- Improved office efficiency by effectively managing internal communications and correspondence.
Reimbursement Customer Service Supervisor
Crescendo Bioscience Inc.-South San Francisco, CA
07.2016 - 07.2017
- Reviewed and conducted reviews on account and service histories to identify trends and issues
- Delivered fast, friendly, and knowledgeable customer service to patients and vendors
- Handled complaints with providers, sales team, and patients
- Managed 6 employees while providing leading, leadership and delegating job assignments
- Tracking project status, processing payroll, scheduling itineraries.
- Resolved issues to maximize productivity
- Researched Investigated, identified and rectified assigned account discrepancies with the salesteam.
- Performed administrative tasks, including answering multiline call center, handled managed departmental professional all billing, waivers, and claims for private and commercial payers
- Identified new workflow techniques to improve workflows and addressed standardized processes, and discussed each process with the Director
- Researched industry standards and processes, and communicated insurance requirements, including patient financial responsibilities and fee-for-service to the department
- Enforced compliance with organizational policies and federal requirements regarding HIPAA
- Contacted insurance providers to verify correct insurance information, including
- Obtain authorization for proper billing codes
- Maintained departmental, management departmental meetings, attendance records, taking note of departmental staff vacation time, sick days, and personal days to ensure compliance with company policies and procedures
- Tracked and submitted employee time sheets to the accounting department for payroll processing
Reimbursement Specialist
Counsyl Inc.-South San Francisco, CA
11.2014 - 06.2015
- Built a loyal client base by working relentlessly to resolve billing problems.
- Improved customer satisfaction by providing exceptional customer service to the sales team, and patients regarding insurance bills.
- Applied Adhered to HIPAA Privacy and Security Regulations
- Investigated insurance denials and collaborated with our team and 3rd-party representatives for resolution
- Identified new workflow techniques to improve workflows standard processes within the department, and addressed discussed each technique with the management team.
- Prevented delays and claim denials by correcting information prior to submission.
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
Education
Gurnick Academy of Medical Arts
11.2023
Associate of Applied Science - Health Care Administration
William Rainey Harper College
Palatine, ILHigh School Diploma -
Schaumburg High School
Schaumburg06-1995
Skills
- Knowledge of HIPAA regulations
- Microsoft Office/Excel
- Healthcare administration expertise
- Clear interpersonal communication
- Fundamental medical terminology
- Health information systems expertise
- Proficient in working with diverse patient populations
Certification
- CCMA Certification
- Medical Billing Certification
Timeline
Reconciliation Specialist
Concentra-Lombard, IL
09.2022 - Current
Benefit Review Specialist
Option One Capital-Fremont, CA
10.2019 - 01.2020
Reimbursement Customer Service Supervisor
Crescendo Bioscience Inc.-South San Francisco, CA
07.2016 - 07.2017
Reimbursement Specialist
Counsyl Inc.-South San Francisco, CA
11.2014 - 06.2015
Gurnick Academy of Medical Arts
Associate of Applied Science - Health Care Administration
William Rainey Harper College
High School Diploma -
Schaumburg High School
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