KATHLEEN BOYLE
Forked River,NJ
Summary
Over 25 years of experience in the Legal and Medical, and Insurance fields, including Office Management, Data Entry, Customer Service, Claims, Billing, Coding, EMR and Auditing.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
26
26
years of professional experience
1
1
Certification
7
7
years of post-secondary education
Work History
Clinical Care Coordinator/CM I Plan 7160 DSNP
HBCBS of NJ
- Timely completion of member centric care plans for Social Workers, LPN’s and RN’s per standards of practice and current organizational policies.
- Review and encourage member participation and compliance w/DSNP program.
- Coordinate delivery of high quality, cost effective care based on member needs for managed long term support and services.
- Comprehensive and accurate documentation p/government program protocols.
ER/ICU Unit Secretary
St. Barnabas/Community Medical Center
01.2014
- Organized and prepared daily schedules for ER Physicians.
- Liaison between ER Staff, Admissions and chart maintenance.
- Communicated with Specialty Providers for STAT ER Care.
- Daily Bed Board entry to assure smooth flow from ER to inpatient status;
- ER Patient Assistance, included discharge documentation and grief counseling services.
- Assist w/ER staff and physicians to maintain urgent care flow.
Insurance Billing Specialist
FL Medical Pain Management & Specialty Surgery Center
01.2011
- Prepared outpatient ambulatory surgery billing, coding and auditing.
- Completed and submitted personal injury/auto accident claims.
- Reviewed patient benefits and coordinated care with providers, physical therapists and nutritional consultants.
- Collected and validated data, reviewed, organized and resolved claims with attorneys and county court system for personal injury claims resolution.
Clinical Care Coordinator/Prior Authorization
HBCBS of NJ
01.2014 - 01.2016
- Complete authorization requests from Providers on behalf of members from medical offices, hospitals and health care facilities.
- Enter and review faxed authorization requests and approve per company protocol utilizing diagnostic codes ICD-10, CPT, HCPCS.
- Prepare, document, and route cases for clinical review.
- Commercial insurance outreach to members to ensure compliance w/required diagnostic exams and medication fill and refill reminders.
- Focus on member/provider satisfaction, accountability and resolution.
Program Coordinator
InCompass Health/Morton Plant Hospital
01.2011 - 01.2013
- Coordinated inpatient billing, coding and auditing services for 16 full time and 4 locum tenens Hospitalists.
- Maintained office equipment, supplies and scheduled monthly meetings for staff.
- Collected daily and monthly patient census and provided management with patient care projections to evaluate staff requirements.
- Evaluated monthly accounts receivables and provided billing resolutions.
Billing/Medical Records Specialist
Integrity Pharmacy
01.2008 - 01.2010
- Maintained Long Term Care and Assisted Living medical records.
- Processed requests and claims for Durable Medical Supplies.
- Processed prescription fills and refills for daily delivery to patients.
- Completed and processed claims, authorizations and appeals.
- Maintained accounts receivable and resolved past due accounts.
Pharmacy Technician
Sam’s Club Pharmacy
01.2005 - 01.2007
- Entered patient demographics and verified insurance information.
- Reconciled patient insurance claims issues with insurance carriers.
- Completed patient prescription fills and refill requests.
- Contacted providers to clarify refill requests and transfer prescriptions from other states and local dispensaries.
- Conducted monthly pharmacy inventory per company protocol.
Administrative Assistant/Paralegal
Hurley & McCrea, P.A., LLC
01.1990 - 01.2004
- Processed and served subpoenas and scheduled court appearances.
- Researched and prepared litigation and real estate documents.
- Prepared billing statements and reconciled client accounts.
- Ordered office supplies and maintained office supply inventory.
- Prepared payroll and tax documentation for office and employees.
Education
Associate of Arts - General Studies
Ocean County College
01.2014 - 05.2016
Certified Professional Coder - Certified Professional Coder
Ultimate Medical Academy
Clearwater, FL 01.2010 - 11.2010
Paralegal Business Certificate - Business
Katharine Gibbs
01.1983 - 12.1983
No Degree - LIberal Arts
Syracuse University
Syracuse, NY 08.1976 - 06.1978
Certified Professional Medical Auditor - Medical Coding
Ultimate Medical Academy
Clearwater, FL 01.2010 - 01.2011
Skills
- NextGen 360, Tableau, Care Radius, Prime Therapeutic, NJMMIS, Microsoft (Word, Excel, Access Microsoft Teams), Beacon Cerner, UCSW, and Encoder Pro
- Strong Focus on Customer Service Excellent oral and written communication skills Team player with strong analytical and interpersonal skills Emotional Intelligence - Able to assist members through difficult situations with comprehensive understanding of insurance plan as well as compassion and patience Knowledge of contracts, enrollment, billing, claims, coding, auditing and accounts receivable Ability to analyze and resolve problems Ability to apply software programs and systems Proficient in Anatomy, Physiology and Medical Terminology ICD-10CM, HCPC, CPT
- Case management
- Clinical documentation
- Insurance practices
- HIPAA compliance
- Goal setting
- Organizational skills
- Documentation
- Medical terminology
- Process improvements
- Monitoring tools
- Patient education
- Patient confidentiality
- Healthcare operations
- Care planning
Certification
- Certified Professional Coder 2010
- Certified Professional Medical Auditor 2011.
Awards
Voted Master Communicator by HBCHS team members., Step It Up Awards from HBCBS director, supervisors, managers, and co-workers., Corporate recognition for compiling a diagnostic and procedural in-house authorization Excel tool for clinical staff January 2016., Treasurer American Association of Professional Coders, Clearwater, FL 2012-2013., Call samples provided for state and federal agency audits as examples of excellent member outreaches per standards of practice and current organizational policies.
Recognition Leasership
Voted Master Communicator by HBCHS team members.
Step It Up Awards from HBCBS director, supervisors, managers, and co-workers.
Corporate recognition for compiling a diagnostic and procedural in-house authorization
Excel tool for clinical staff January 2016.
Treasurer American Association of Professional Coders, Clearwater, FL 2012-2013.
Call samples provided for state and federal agency audits as examples of excellent member outreaches per standards of practice and current organizational policies.
Timeline
Associate of Arts - General Studies
Ocean County College
01.2014 - 05.2016
ER/ICU Unit Secretary
St. Barnabas/Community Medical Center
01.2014
Clinical Care Coordinator/Prior Authorization
HBCBS of NJ
01.2014 - 01.2016
Insurance Billing Specialist
FL Medical Pain Management & Specialty Surgery Center
01.2011
Program Coordinator
InCompass Health/Morton Plant Hospital
01.2011 - 01.2013
Certified Professional Coder - Certified Professional Coder
Ultimate Medical Academy
01.2010 - 11.2010
Certified Professional Medical Auditor - Medical Coding
Ultimate Medical Academy
01.2010 - 01.2011
Billing/Medical Records Specialist
Integrity Pharmacy
01.2008 - 01.2010
Pharmacy Technician
Sam’s Club Pharmacy
01.2005 - 01.2007
Administrative Assistant/Paralegal
Hurley & McCrea, P.A., LLC
01.1990 - 01.2004
Paralegal Business Certificate - Business
Katharine Gibbs
01.1983 - 12.1983
No Degree - LIberal Arts
Syracuse University
08.1976 - 06.1978
Clinical Care Coordinator/CM I Plan 7160 DSNP
HBCBS of NJ
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