Kathy Nelson
Mexia,TX
Summary
Accomplished Reimbursement Lead II at Heart of Texas Behavioral Health Network, adept in HCPCS coding and fostering team collaboration. Streamlined claims processing, enhanced reimbursement rates, and implemented quality assurance measures, significantly reducing denial rates. Skilled in office administration and HIPAA compliance, demonstrating a strong ability to improve financial outcomes and team efficiency.
Overview
18
18
years of professional experience
Work History
Reimbursement Lead II
Heart of Texas Behavioral Health Network
10.2018 - Current
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Prevented delays and claim denials by correcting information prior to submission.
- Improved reimbursement rates by implementing efficient claim submission processes and maintaining accurate records.
- Provided ongoing training to staff members, enhancing knowledge of coding updates and payer requirements.
- Reduced denials with thorough pre-authorization and eligibility verification procedures.
- Streamlined workflows for increased productivity by optimizing scheduling and resource allocation.
- Analyzed trends in denial patterns to proactively address issues impacting payment outcomes.
- Implemented quality assurance measures to reduce errors in claim submissions and increase reimbursement success rates.
- Promoted teamwork through effective communication practices and collaboration initiatives among team members.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
OFFICE ADMINISTRATOR
Angelina Counseling
07.2015 - 03.2018
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Maintained electronic and paper filing systems for easy retrieval of information.
- Coordinated communications, financial processing, registration, recordkeeping, and other administrative functions.
- Reconciled account files and produced monthly reports.
- Maintained confidentiality of sensitive information, adhering to strict data protection policies.
- Streamlined appointment scheduling for executives, optimizing their daily agendas for maximum productivity.
Human Resources Intern
Anderson Cherokee Community Enrichment Services
09.2006 - 01.2015
- Filed paperwork, sorted, and delivered mail and maintained office organization.
- Answered phone and performed clerical duties to assist human resources department.
- Created and updated tracking spreadsheets using MS Excel.
- Recorded employee complaints and helped resolve conflicts to address issues quickly and promote healthy work environments.
- Developed training materials that contributed to professional growth of staff members.
- Supported HR managers in mediating conflicts, restoring team harmony.
- Administered employee benefits programs and assisted with open enrollment.
- Developed and implemented onboarding and orientation programs for new employees.
- Collaborated with managers to identify and address employee relations issues.
- Assisted with payroll processing tasks ensuring timely payments for all employees without discrepancies.
Education
High School Diploma -
East Central High School
Tulsa, OK05-1982
Skills
- HCPCS coding
- Office administration
- HIPAA compliance
- Healthcare reimbursement
- Database entry
- Claims processing
Timeline
Reimbursement Lead II
Heart of Texas Behavioral Health Network
10.2018 - Current
OFFICE ADMINISTRATOR
Angelina Counseling
07.2015 - 03.2018
Human Resources Intern
Anderson Cherokee Community Enrichment Services
09.2006 - 01.2015
High School Diploma -
East Central High School
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