Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kathryn J. Bayly

Omaha,USA

Summary

Certified Professional Coder (AAPC) with years of experience in managed care organizations and health insurance environments. Exceptional critical thinking and attention to detail, complemented by strong written and verbal communication skills, including the ability to effectively present complex information. Capable of working independently with minimal supervision while managing multiple tasks and shifting priorities in a fast-paced setting. Known for team collaboration and adaptability, ensuring seamless operations and positive outcomes. Skills include problem-solving, communication, and negotiation.

Overview

22
22
years of professional experience

Work History

Recovery/Resolution Consultant/Team Lead

Optum
08.2023 - Current
  • Lead a team for Fraud appeals and Recon reviewers
  • Provide guidance and support to team members, upper management, legal and top leadership
  • Researching state and federal guidelines and UHC reimbursement policies
  • Reviews QA errors timely, performs rebuttal tasks, and ensures the error is rectified
  • Leads out new employee training or cross training functions, also identifies cross training needs
  • Helping with inventory volume when needed.

Recovery/Resolution Consultant/SME

Optum
09.2017 - 08.2023
  • Maintaining the Help Desk for high level coding questions
  • Auditing escalated claims form all lines of business and specialty types
  • Applying UHC reimbursement policies were applicable
  • Researching reimbursement, review guidelines for guidance to reviewers
  • Meeting with providers to provide coding education

Senior Recovery/Resolution Analyst

Optum
02.2015 - 09.2017
  • Performing pre-pay reviews
  • Working in NICE, DETECTS, EncoderPro, Fastireve, Knowledge Library
  • Meeting above 100% of goal for production

Certified Coder

Midwest Gastrointestinal Associates
06.2014 - 02.2015
  • Coding and entering inpatient and outpatient E/M for Gastrointestinal
  • Coding and entering invasive procedures for Gastrointestinal
  • Answering billing and coding questions from physicians and patients

Coding Specialist

StrategicHealthSolutions, LLC
09.2013 - 06.2014
  • Perform medical coding audits of the providers to find inefficiencies and discrepancies within hospital or physician’s billing systems requested by CMS or the OIG
  • Research Federal and State regulations for the relevancies to the audit being performed
  • Current audits worked are E/M, TEI, and Herceptin.

Coding Analyst

Alegent Creighton Health
04.2012 - 08.2013
  • Performing physician E/M coding audits for Hospital Medicine
  • Performing physician training both individually and in a group setting
  • Entering and/or correcting charges in the hospital billing system

Medical Coder

Kforce
11.2011 - 04.2012
  • Coding both CPT (surgical and E/M) and ICD-9 codes for a variety of specialties
  • Coding E/M codes for a large hospitalist group
  • Entering and/or correcting charges in EPIC

Coding Auditor

Integriguard, LLC
01.2010 - 11.2011
  • Perform medical coding field and desk audits of the providers to find inefficiencies and discrepancies within hospital or physician’s billing systems
  • Research State Medicaid regulations for the relevancies to the audit being performed
  • Perform Quality Assurance on peers work to make sure they are upholding the companies quality standards

Coder

ProCoding Solutions
01.2011 - 07.2011
  • Coding inpatient and outpatient E/M and outpatient colonoscopies
  • Entering charges into the billing system

Medical Coding and Billing Specialist

UNMC Physicians
11.2008 - 01.2010
  • Coding both CPT and ICD-9 codes to anesthesia records
  • Coding outpatient E/M and injections for the Pain clinic
  • Entering all charges into the billing system with a 95% accuracy rate or better

Provider Credentialing Analyst

Coventry HealthCare
05.2008 - 11.2008
  • Enter new provider information into system
  • Update existing provider contract information

Certified Coder

Creighton University
02.2004 - 05.2008
  • Coding inpatient and outpatient E/M for Cardiology and Neurosurgery
  • Coding surgeries and invasive procedures for Cardiology and Neurosurgery
  • Answering all billing and coding questions from physicians and patients

Education

Certificate - Certified Coder

AAPC
01.2004

Skills

  • Self-awareness
  • Confident decision-making
  • Conflict resolution techniques
  • Building rapport
  • Team collaboration
  • Analytical problem-solving
  • Effective time management
  • Strong attention to detail
  • Proficient in handling multiple tasks
  • Exhibits professionalism in high-stress situations
  • Adaptability to change
  • Collaborative partnership development

Timeline

Recovery/Resolution Consultant/Team Lead

Optum
08.2023 - Current

Recovery/Resolution Consultant/SME

Optum
09.2017 - 08.2023

Senior Recovery/Resolution Analyst

Optum
02.2015 - 09.2017

Certified Coder

Midwest Gastrointestinal Associates
06.2014 - 02.2015

Coding Specialist

StrategicHealthSolutions, LLC
09.2013 - 06.2014

Coding Analyst

Alegent Creighton Health
04.2012 - 08.2013

Medical Coder

Kforce
11.2011 - 04.2012

Coder

ProCoding Solutions
01.2011 - 07.2011

Coding Auditor

Integriguard, LLC
01.2010 - 11.2011

Medical Coding and Billing Specialist

UNMC Physicians
11.2008 - 01.2010

Provider Credentialing Analyst

Coventry HealthCare
05.2008 - 11.2008

Certified Coder

Creighton University
02.2004 - 05.2008

Certificate - Certified Coder

AAPC
Kathryn J. Bayly