Summary
Overview
Work History
Education
Skills
Timeline
ResearchAssistant
Kathleen Young

Kathleen Young

Summary

Dear: Human Resources

Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills.

Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

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

45
45
years of professional experience

Work History

MEDICAL CREDENTIALING CONTRACTING AUDEIT BILLING

Sleep Medicine Associates
10.2022 - 04.2023
  • Optimized organizational systems ensuring that all claims have the correct CPT, ICD-10 codes with attachments if needed for payment, AR, deposits, and appeals.
  • Answered patient questions so they could be promptly addressed.
  • Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
  • Developed internal requirements and standards to minimize regulatory risks and liability across programs.
  • Initiated contact with insurance companies to update contracting information.
  • Contacted insurance companies that we were not contracted with, created letter of intent and supporting documents for their contracting department.
  • Evaluated Encounters for patients to submit authorizations to Utilization Review departments.
  • Faxed supporting documents for Utilization Review for authorizations.
  • Created a fax face sheet with complete information what is needed for authorizations.
  • Created spreadsheets (cheat sheets)for all employees that are involved with, authorizations, billing, and scheduling.
  • Cleared all back log of claims in Athena.
  • Ensured that all claims that were being created had proper CPT, Modifiers, and ICD-10 codes.
  • Addressed denied claims for appeal, when needed.
  • Improved customer satisfaction through application of superior conflict resolution and problem-solving skills.
  • Created spreadsheets for tasks to administrate and support staff to organize and improve office efficiency.
  • Built highly-efficient administrative team through coaching and professional development opportunities.
  • Organized meetings for executives and coordinated availability of conference rooms for participants.
  • Organized spaces, materials and support for internal and client-focused meetings.
  • Conducted ongoing reviews of program financial systems to assess control measures.
  • Trained team members on new contracted payers and products to support employees in efforts obtain patient's correct information.
  • Implemented techniques to overcome obstacles and increase team productivity.
  • Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
  • Planned, monitored and appraised employee work results by training managers to coach and discipline employees.
  • Enrolled providers and Medicaid, Medicare and private insurance plans.
  • Improved organizational filing systems for confidential patient records, resulting in improved accessibility and efficiency.
  • Improved office efficiency by effectively managing internal communications and correspondence.
  • Prepared records for site visits and file audits.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Conducted primary source verifications such as background checks and board certifications.
  • Received and evaluated applications to look for missing and inaccurate information.

MEDICAL WOUND CARE CODER

DT-Trak Consulting
01.2017 - 01.2020
  • Utilize three computer program systems for medical coding, DOS RPMS, EHR RPMS, DT-Trek Coder
  • Translated medical record to CPT and ICD-10 codes
  • Audited 1500 format to ensure proper payment
  • Analyze request for payment from government insurance.
  • ·Corrected HICFA for correct and quick payment
  • Read SOAP to ensure correct CPT and ICD codes were used for payment.
  • Resourcefully used various coding books, procedure manuals, and on-line encoders.
  • Used classification manuals to gain additional knowledge of disease and diagnoses processes.
  • Maintained accuracy, completeness, and security for medical records and health information.
  • Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Generated reports to identify coding trends and discrepancies.
  • Researched and resolved medical record discrepancies.
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Communicated with insurance companies to research and resolved coding discrepancies.
  • Monitored changes in coding regulations to provide recommendations for compliance.
  • Utilized electronic medical record systems to store, retrieve and process patient data.
  • Followed up with medical staff regarding missing information in patient records.
  • Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
  • Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
  • Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
  • Reviewed patient charts to better understand health histories, diagnoses, and treatments.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.

MEDICAL OUTPATIENT WOUND CARE CODER

Aerotek Aviation
01.2016 - 12.2016
  • Tracked and monitored requests for medical records release.
  • Generated reports to identify coding trends and discrepancies.
  • Processed and tracked requests for medical records from external organizations.
  • Verified signatures and checked medical charts for accuracy and completion.
  • Monitored changes in coding regulations to provide recommendations for compliance.
  • Developed and implemented new filing system for medical records to improve efficiency.
  • Generated and maintained statistical data related to medical records.
  • Identified new methods to optimize medical records management.
  • Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
  • Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Utilized electronic medical record systems to store, retrieve and process patient data.
  • Followed up with medical staff regarding missing information in patient records.
  • Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
  • Communicated effectively with staff, patients, and insurance companies by email and telephone.
  • Researched and resolved medical record discrepancies.
  • Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
  • Input data into computer programs and filing systems.
  • Communicated with insurance companies to research and resolved coding discrepancies.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.
  • Maintained accuracy, completeness, and security for medical records and health information.
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Reviewed patient charts to better understand health histories, diagnoses, and treatments.

MEDICAL BILLING GOVERNMENT CLAIMS AUDITOR

Robert Half
01.2015 - 11.2015
  • Coordinated, managed and implemented auditing projects and prepared for evaluation.
  • Obtained and interpreted relevant and authoritative criteria for program or issues under audit.
  • Partnered with auditors to track errors and add contributions to maintain accuracy.
  • Communicated with audited staff to obtain necessary information for audits.
  • Handled complaints and grievances using negotiating and problem-solving skills.
  • Examined claims forms and other records to determine insurance coverage.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues.
  • Finalized 1500 forms for insurance claim payment release.
  • Researched issues related to claims processing to identify origins and implement corrective solutions.
  • Corrected CPT & ICD-10 codes to properly verify claims.
  • Provided high level of professionalism when speaking with customers or responding to emails to promote company's dedication to service.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Prioritized daily tasks to satisfy workload demands and department's turnaround goals.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Maintained claims data in Epic systems.
  • Used Excel, set up functions and enter data for claims.

MEDICAL ELIGIBILITY & AUTHORIZATIONS

Human Resource NetWork
08.2014 - 12.2014
  • Built relationships with diverse stakeholders to achieve successful program implementation.
  • Processed and certified documents for accuracy and compliance with government regulations.
  • Reviewed applications for different aid programs and determined which qualification criteria for individuals.
  • Communicated with people from various cultures and backgrounds on application process.
  • Collected pertinent data and calculations to aid physician in interpreting results.
  • Verified patient insurance coverage and collected required co-payments.
  • Obtained and documented patient medical history, vital signs and current complaints at intake.
  • Completed clinical procedures and gathered patient data for interpretation by physician.
  • Liaised with patients and addressed inquiries, appointment requests and billing questions.
  • Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Obtained client medical history, medication information, symptoms, and allergies.
  • Performed medical records management, including filing, organizing and scanning documents.

MEDICAL CODER/BILLER SPECIALIST

Marathon Staffing
01.2014 - 08.2014
  • Posted and adjusted payments from insurance companies.
  • Maintained and updated collections tracking spreadsheet to help organize payment information.
  • Collected payments and applied to patient accounts.
  • Filed and updated patient information and medical records.
  • Located errors and promptly refiled rejected claims.
  • Liaised between patients, insurance companies, and billing office.
  • Precisely evaluated and verified benefits and eligibility.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Managed collections claims for unpaid bills against estates of debtors.
  • Evaluated patients' financial status and established appropriate payment plans.
  • Prepared billing correspondence and maintained database to organize billing information.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
  • Pre-certified medical and radiology procedures, surgeries and echocardiograms.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Identified and resolved patient billing and payment issues.
  • Communicated effectively and extensively with other departments to resolve claims issues.
  • Communicated with insurance providers to resolve denied claims and resubmitted.

MEDICAL BILLER ACCOUNTS RECEIVIABLE

Fallon Tribal Health Center
09.2013 - 12.2013
  • Audited and corrected billing and posting documents for accuracy.
  • Maintained accurate records of customer payments.
  • Used data entry skills to accurately document and input statements.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.
  • Prepared billing statements for patients and verified correct diagnostic coding.
  • Generated accounts payable reports for management review to aid in financial and business decision making.
  • Delivered timely and accurate charge submissions.
  • Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Adhered to established standards to safeguard patients' health information.
  • Collected payments and applied to patient accounts.
  • Verified insurance of patients to determine eligibility.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Liaised between patients, insurance companies, and billing office.
  • Generated monthly billing and posting reports for management review.
  • Utilized various software programs to process customer payments.
  • Encoded and canceled checks using bank machines.
  • Posted payments and collections on regular basis.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Monitored outstanding invoices and performed collections duties.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.

MEDICAL BILLER CODER DERMATOLOGY PLASTIC SURGERY

Janiga MD's
06.2012 - 06.2013
  • Audited and corrected billing and posting documents for accuracy.
  • Generated accounts payable reports for management review to aid in financial and business decision making.
  • Utilized various software programs to process customer payments.
  • Monitored outstanding invoices and performed collections duties.
  • Verified insurance of patients to determine eligibility.
  • Prepared billing statements for patients and verified correct diagnostic coding.
  • Liaised between patients, insurance companies, and billing office.
  • Posted payments and collections on regular basis.
  • Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
  • Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
  • Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
  • Verified accuracy of accounts payable payments, resulting in 97% reduction in payment errors and check reissues.
  • Adhered to established standards to safeguard patients' health information.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Generated monthly billing and posting reports for management review.
  • Encoded and canceled checks using bank machines.
  • Used data entry skills to accurately document and input statements.
  • Handled account payments and provided information regarding outstanding balances.
  • Collected payments and applied to patient accounts.
  • Delivered timely and accurate charge submissions.
  • Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
  • Collaborated with customers to resolve disputes.
  • Reconciled accounts receivable to general ledger.
  • Maintained accurate records of customer payments.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Responded to customer concerns and questions on daily basis.
  • Processed payment via telephone and in person with focus on accuracy and efficiency.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Filed and updated patient information and medical records.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.

MEDICAL BILLER THIRD PARTY

Washoe Tribal Health Center
01.2012 - 06.2012
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Responded to customer concerns and questions on daily basis.
  • Prepared billing statements for patients and verified correct diagnostic coding.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.
  • Monitored outstanding invoices and performed collections duties.
  • Collaborated with customers to resolve disputes.
  • Processed vendor and supplier payments on weekly basis.
  • Delivered timely and accurate charge submissions.
  • Utilized various software programs to process customer payments.
  • Handled account payments and provided information regarding outstanding balances.
  • Audited and corrected billing and posting documents for accuracy.
  • Maintained accurate records of customer payments.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Processed payment via telephone and in person with focus on accuracy and efficiency.
  • Adhered to established standards to safeguard patients' health information.
  • Posted payments and collections on regular basis.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Verified insurance of patients to determine eligibility.
  • Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
  • Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
  • Reconciled accounts receivable to general ledger.
  • Used data entry skills to accurately document and input statements.
  • Filed and updated patient information and medical records.
  • Liaised between patients, insurance companies, and billing office.
  • Collected payments and applied to patient accounts.
  • Generated monthly billing and posting reports for management review.
  • Generated accounts payable reports for management review to aid in financial and business decision making.
  • Encoded and canceled checks using bank machines.
  • Created improved filing system to maintain secure client data.
  • Disbursed petty cash by recording entries and verifying documentation.
  • Kept vendor files accurate and up-to-date to expedite payment processing.
  • Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
  • Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.

MEDICAL BILLING DATA ADJUDICATION LEAD

Foundation Health/HealthNet
02.1996 - 08.2000
  • Audited and corrected billing and posting documents for accuracy.
  • Maintained accurate records of customer payments.
  • Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
  • Reconciled accounts receivable to general ledger.
  • Generated monthly billing and posting reports for management review.
  • Generated accounts payable reports for management review to aid in financial and business decision making.
  • Used data entry skills to accurately document and input statements.
  • Handled account payments and provided information regarding outstanding balances.
  • Processed payment via telephone and in person with focus on accuracy and efficiency.
  • Responded to customer concerns and questions on daily basis.
  • Created improved filing system to maintain secure client data.
  • Monitored outstanding invoices and performed collections duties.
  • Encoded and canceled checks using bank machines.
  • Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
  • Utilized various software programs to process customer payments.
  • Kept vendor files accurate and up-to-date to expedite payment processing.
  • Collaborated with customers to resolve disputes.
  • Processed vendor and supplier payments on weekly basis.
  • Disbursed petty cash by recording entries and verifying documentation.

MEDICAL BILLING WORKERS COMENSATION SUPERVISOR

O.U.C.H.
08.1978 - 02.1996
  • Filed and updated patient information and medical records.
  • Followed up on legal claims.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Reviewed services rendered and completed to reconcile codes.
  • Delivered timely and accurate charge submissions.
  • Participated in workshops and other training opportunities to remain current on billing procedures, regulations and industry updates.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Enforced operational compliance with state and federal laws and Joint Commission standards.
  • Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.
  • Analyzed medical records to satisfy insurance company mandates.
  • Complied with HIPAA privacy and security regulations to protect patients' medical records and information.
  • Adhered to established standards to safeguard patients' health information.
  • Reviewed outgoing bills for eligibility and accurateness.
  • Verified insurance of patients to determine eligibility.
  • Oversaw billing for Medicaid PCA, waiver and skilled claims, commercial insurance and private pay clients.
  • Verified proper ICD-9 coding on claims.
  • Maintained current accounts through aged revenue reporting.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Devised new methods to improve billing workflows.
  • Assisted patients by determining financial assistance available and setting up payment plans.
  • Prepared billing statements for patients and verified correct diagnostic coding.
  • Confirmed backup and proper storage of sensitive information in event of data breach or outage.

Education

Certification - Certified Medical Biller Coder Specialist

NSCI
Carson City, NV

Certification - COC, CPC, CPB, CBCS

AAPC
Sacramento, CA

Bachelor of Science - Veterinary Medicine (Pre-Veterinarian) & Zoology

University of California At Davis
Davis, CA

Associate of Science - Veterinary Technologies

Western Career Collage
Sacramento, CA

BBA - Business Management

Cosunmnus River College
Sacramento, CA

High School Diploma -

Hiram W Johnson
Sacramento, CA
06.1973

Skills

  • Medical Billing
  • Medical Billing Specialist
  • Medical Billing Experience
  • Medical Billing Processing
  • Medical Billing Knowledge
  • Medical Electronic Billing
  • Medical Billing Processing
  • Medical Insurance Billing
  • Medical Professional Billing
  • Medical Facility Billing
  • Medical Patient Billing
  • Medical Billing Arrangements
  • Medical Billing Management
  • Medical Billing Supervision
  • Medical Billing Resolutions
  • Medical Billing Analysis
  • Medical Billing Adjustments
  • Medical Billing Inquiries
  • Medical Billing Review
  • Medical Billing Review of Encounters
  • Medical Billing Update
  • Medical Billing Security
  • Medical Billing Discrepancy
  • Medical Billing Documentation
  • Medical Billing Software, Epic, 3M, DOS, NexGen, Athena, and more
  • Medical Billing Accuracy
  • Medical Billing Research
  • Medical Telecommunications Billing
  • Medical Billing Oversight
  • Medical Billing Codes, CPT and ICD-10
  • Medical Billing Procedures, Encounter Review, Proper Codes for 1500 Form, Electronic Claims Submission, Paper Claims Submission, Payer Contractual Agreements for Payment
  • Medical Billing Proficiency
  • Medical Billing Software, Variety
  • Medical Billing Protocol, Timely Filing According to Payer
  • Medical Denials and Appeals Process
  • Medical Billing Error Resolution, Denials and Appeals According to Payer Contract
  • Medical Contract Charge and Billing
  • Medical Billing Data Analysis
  • Medical Billing Problem Resolution
  • Medical Billing Department Support
  • Medical Billing Cycle Management
  • Medical Financial Billing Management
  • Medical Knowledge of CPT and ICD-10 Codes
  • Medical Supervisor and Lead Biller
  • Medical Credentialing and Contracting
  • Medical Workers Compensation, Government, Outpatient Wound Care, Sleep Medicine, Dermatology, Plastic Surgery Coding and Billing Experience

Timeline

MEDICAL CREDENTIALING CONTRACTING AUDEIT BILLING

Sleep Medicine Associates
10.2022 - 04.2023

MEDICAL WOUND CARE CODER

DT-Trak Consulting
01.2017 - 01.2020

MEDICAL OUTPATIENT WOUND CARE CODER

Aerotek Aviation
01.2016 - 12.2016

MEDICAL BILLING GOVERNMENT CLAIMS AUDITOR

Robert Half
01.2015 - 11.2015

MEDICAL ELIGIBILITY & AUTHORIZATIONS

Human Resource NetWork
08.2014 - 12.2014

MEDICAL CODER/BILLER SPECIALIST

Marathon Staffing
01.2014 - 08.2014

MEDICAL BILLER ACCOUNTS RECEIVIABLE

Fallon Tribal Health Center
09.2013 - 12.2013

MEDICAL BILLER CODER DERMATOLOGY PLASTIC SURGERY

Janiga MD's
06.2012 - 06.2013

MEDICAL BILLER THIRD PARTY

Washoe Tribal Health Center
01.2012 - 06.2012

MEDICAL BILLING DATA ADJUDICATION LEAD

Foundation Health/HealthNet
02.1996 - 08.2000

MEDICAL BILLING WORKERS COMENSATION SUPERVISOR

O.U.C.H.
08.1978 - 02.1996

Certification - Certified Medical Biller Coder Specialist

NSCI

Certification - COC, CPC, CPB, CBCS

AAPC

Bachelor of Science - Veterinary Medicine (Pre-Veterinarian) & Zoology

University of California At Davis

Associate of Science - Veterinary Technologies

Western Career Collage

BBA - Business Management

Cosunmnus River College

High School Diploma -

Hiram W Johnson

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Kathleen Young