KATRINA R. WEAVER
Dallas,TX
Summary
A challenging and rewarding position in a growth –oriented organization, which offers opportunity for advancement and professional development. Efficient Reimbursement Specialist with solid background proactively managing claims and preventing insurance issues. Competent in keeping records accurate and current and proactively managing account problems. Excellent customer relations skills combined with analytical approach to handling routine and complex delays.
Overview
15
15
years of professional experience
1
1
Certificate
Work History
IOM OON Reimbursement Specialist
Medical Practice Solutions
Richardson, TX
05.2016 - Current
- Collecting on IOM OON accounts various Insurance Companies, Revenue of over 6 million
- Responsible for bringing revenue on assigned accounts over 950k monthly/Follow up on newly billed
- Negotiate accounts with various Insurance Companies to settle patients accounts with HAS/no OON Benefits and ERISA self- funded plans
- Training new employees/Researching information on various request Authorizations/ Pre Cert
- Made adjustments to patient accounts bringing them to a zero balance, post payments, charge entry
- Utilizing Availity, UHC and Navinet for claims, and remittance information Certified Payment Processing
Out-of-Network Billing/Collections Specialist
Intergrated Medical Management
Plano, TX
08.2019 - 06.2021
- Negotiated to collect balance in full.
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
- Processed payments and applied to customer balances.
- Achieved performance goals on consistent basis.
- Submitting appeals as needed to adjudicate pending or denied insurance claims
- Appealing all bundling and other claim denials to insure payment according to patient plan and contracts
- Auditing all surgical charges for coding optimization, error and compliance with applicable laws and regulations. Notifying physicians, or other providers of such errors promptly and in an instructive manner.
Recruiting Specialist
Carrollton, TX
01.2015 - 03.2016
- Hired employees and initiated new hire paperwork process.
- Tracked candidates and pushed for feedback on disqualifications, time-to-fill statistics and other variables.
- Promptly corresponded with applicants and coordinated and conducted interviews.
- Explained human resources policies, procedures, laws, standards and regulations to each employee.
- Supported management in developing and implementing personnel policies and procedures.
- Evaluated strengths and weaknesses of candidates through effective screening processes.
Senior Imaging Specialist - Team Lead
Coventry Worker’s Compensation
Dallas, TX
02.2013 - 12.2014
- Research and responds to inquiries from internal departments for issues such as missing mail receipts or unconfirmed batches
- Maintains production and quality standards
- Demonstrates expert subject matter knowledge
- Assesses training needs within the team
- Serves as a training resource, mentor and coach to others particularly new hires
- Acts independently and manages own activities with minimal supervision and direction
- Assist other team members, takes ownership for problem resolution
- Demonstrates advocates and reinforces a positive team environment
- Performs other office duties as assigned.
Operations Support Analyst
HMS- Health Management Systems
Irving, TX
05.2011 - 07.2013
- Responsible for managing the monthly invoicing reconciliations and all clients’ deliverables for assigned state contracts, in accurate and timely fashion
- Includes reviewing overpayments, reviewing job output reports, and updating Excel Files for remits, lockbox reconciliation, invoice letters and necessary attachments
- Manage daily Macro posting process to the internal Accounts Receivable system, and process the electronic remittances for select healthcare payer
Health Insurance Specialist
Trailblazer Health Enterprise, H.M.O
Dallas, TX
03.2009 - 04.2011
- Researching and responding to telephone inquiries, make outgoing phone contacts with CMS regional offices, HMO’s and Medicare Help Line regarding special situations
- Completing necessary paperwork and follow-ups
- Gathering info for completion case file while complying with all CMS rules and regulations.
Education
Bryan Adams High School
M.B.C - Medical Insurance Billing & Coding
Sanford Brown College
03.2011
M.A - Medical Assistant
PCI Health Training
1996
Skills
- Administrative operations in a medical facility
- Computer skills include
- Microsoft Word, Excel, and PowerPoint General office equipment Scanning medical document Medical Billing & Coding ICD-9-ICD-10 and HCPCS CPT coding knowledge Co-Payments & Deductibles
- HIPPA Compliance, Insurance Billing Procedures, Insurance Verification Medicare, Medicaid & Tricare
- CMS-1500, UB-04
- EOB’s
- Managed Care (HMO, PPO, and POS) Claims Processing, Electronic Payment Posting, Government & Third Party Payers, Data Entry
- Determine Medical Necessity
- Account Posting
- Itemized Statement Preparation
- Accounts Payable and Accounts Receivable
Certification
- CBCS - Certified Billing and Coding Specialist
Timeline
Out-of-Network Billing/Collections Specialist
Intergrated Medical Management
08.2019 - 06.2021
IOM OON Reimbursement Specialist
Medical Practice Solutions
05.2016 - Current
Recruiting Specialist
01.2015 - 03.2016
Senior Imaging Specialist - Team Lead
Coventry Worker’s Compensation
02.2013 - 12.2014
Operations Support Analyst
HMS- Health Management Systems
05.2011 - 07.2013
Health Insurance Specialist
Trailblazer Health Enterprise, H.M.O
03.2009 - 04.2011
Bryan Adams High School
M.B.C - Medical Insurance Billing & Coding
Sanford Brown College
M.A - Medical Assistant
PCI Health Training