KAYLA BURNS
Great Falls,MT
Summary
Claims Liaison who possesses knowledge of medical terminology as well as ICD9 Codes/ ICD10 Codes, CPT Codes, CPT Modifiers, Medicare Billing Codes, CDT Codes (Dental), NDC Drug Codes, DRG Medicare Codes, Taxonomy Codes and HCPCS coding. Knowledge of provider contracts and fee schedules. Uses a variety of programs on PC platform such as Excel and MS Office Professional. Utilized various clearinghouses. Proficient in reimbursement guidelines, team leadership, and patient advocacy. Previous experience in hospital government billing and collecting, specifically Medicare and Medicaid. Experience analyzing insurance claims, including government, PPO, and capitated plans.
Overview
21
21
years of professional experience
Work History
Claims Liaison
Centene Corporation
07.2024 - Current
- Audit check run and send claims to the claims department for corrections.
- Identify any system changes and work notify the Plan CIA Manager to ensure its implementation.
- Collaborate with the claims department to price pended claims correctly.
- Document, track and resolve all plan providers’ claims projects.
- Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication.
- Identify authorization issues and trends and research for potential configuration related work process changes.
- Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes.
- Identify potential and documented eligibility issues and notify applicable departments to resolve.
- Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.
- Run claims reports regularly through provider information systems.
- Research verbal and written providers’ claims inquiries as needed.
Lead Claims Analyst
Centene Corporation
04.2023 - 07.2024
- Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims
- Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis
- Assist in creating work flows for the department and support team members in understanding changes in work processes
- Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues
- Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions
- Maintains records and reports as assigned
- Assist in meeting departmental production and quality standards
- Process claims when needed
Senior Claims Support Analyst
Centene Corporation
11.2021 - 04.2023
- Serve as the subject matter expert on claims knowledge to address proficiency gaps on the floor in a timely manner
- Provide in-person and virtual training as needed to support claims training
- Act as a support to the Claims Training team by conducting regular reviews of the work processes to ensure accuracy
- Review, investigate, adjust and resolve claims, claims appeals, inquiries, and inaccuracies in payment of claims
- Review specific claim categories to i)-validate interest payments (including high dollar interest and U9 interest payment reviews), ii)-validate authorization denials to ensure proper processing of claims, iii)-validate claims prior to check runs, etc
- Conduct claims quality reviews for processing for accuracy
- Document results and identify trends/systemic root cause analysis
- Maintain appropriate records, files, documentation, etc
- Meet established quality, turn-around time and interest reduction metrics
- Assists team lead with reviewing and updating workflows
- Review and process aging claims
- Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility
- Ensure payments and/or denials are made in accordance with company practices and procedures
- Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied
- Claims processing may be related to physician and hospital services, special pricing, and adjustments on resubmitted claims
- Research and determine status of medical related claims
- Review charges, access the computer system and use payment or denial codes within established department guidelines and standards
- Maintain records, files, and documentation as appropriate
- Meet department production and quality standards
- Assist with checkrun
- Resolve member/provider and health plan requests through OMNI
- Any other tasks as required
Claims Analyst
Centene Corporation
08.2020 - 11.2021
- Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility
- Ensure payments and/or denials are made in accordance with company practices and procedures
- Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied
- Claims processing may be related to physician and hospital services, special pricing, and adjustments on resubmitted claims
- Research and determine status of medical related claims
- Review charges, access the computer system and use payment or denial codes within established department guidelines and standards
- Maintain records, files, and documentation as appropriate
- Meet department production and quality standards
- Assist with checkrun
- Resolve member/provider and health plan requests through OMNI
- Any other tasks as required
Service Specialist II
CPSI
04.2020 - 02.2021
- Prepare and submit hospital claims to insurance carriers both electronic or hard copy billing
- Secure medical documentation required by insurance
- Work Medicare accounts in Direct Data Entry system
- Work denials from insurance to get claims paid
Hospital Biller/Collector
Great Falls Clinic
08.2017 - 04.2020
- Prepare and submit hospital claims to insurance carriers both electronic or hard copy billing
- Assisted in training new hospital billers and collectors
- Secure medical documentation required by insurance
- Work denials from insurance to get claims paid
- Provide guidance to both internal and public personnel
- Add charges to accounts given from coding team
- Work Medicare accounts in Direct Data Entry system
- Used Scripted conversation prompts to convey current account information and obtain payments
- Identified, researched, and resolved billing variances to maintain system accuracy and currency
Hospital Government Biller/Collector
Benefis Health System
11.2014 - 08.2017
- Prepare and submit hospital claims to insurance carriers both electronic or hard copy billing
- Assisted in training new hospital billers and collectors
- Secure medical documentation required by insurance
- Review and follow-up on unpaid claims
- Work denials from insurance to get claims paid
- Work Medicare accounts in Direct Data Entry system
- Provide guidance to both internal and public personnel
- Verify patient benefits eligibility and coverage
- Reviewing open accounts base on A/R aging reports showing30,60,90 and120 days past due
- Taking patient and insurance phone calls while providing excellent customer service to resolve billing problems and questions
Patient Account Representative
Benefis Health System
09.2013 - 11.2014
- Managed patient calls effectively and efficiently in a complex, fast-paced and challenging call center environment
- Assisted in training new patient account representatives
- Provided accurate and appropriate information in response to patient inquiries
- Ran reports and supplied data to fulfill patient report requirements
- Assisted patients with billing and insurance inquiries
- Took payments via phone for patient accounts
Interim Kitchen Supervisor
Benefis Health System
01.2010 - 09.2013
- Directed activities of team of skilled kitchen workers preparing and serving meals
- Created and deployed successful strategies to boost restaurant performance, streamline food prep processes and reduce waste
- Oversaw grill, stove and oven and cleaned equipment after every shift
- Continuously evaluated business operations to effectively align workflows for optimal area coverage and customer satisfaction
- Monitored food preparation, production and plating for quality control
Call Center Service Representative
Benefis Health System
05.2006 - 09.2013
- Gathered and verified all required customer information for tracking purposes
- Assisted in training new call center service representatives
- Assisted in the implementation of a new food service program at a healthcare facility in Idaho
- Effectively managed a high-volume of inbound and outbound patient calls
- Managed patient and staff calls effectively and efficiently in a complex, fast paced and challenging call center environment
Food Service Worker
Benefis Health System
05.2006 - 09.2013
- Rounded on assigned floors to assist and take patient meal orders
- Assisted in training new meal attendants
- Rounded on all hospital floors to restock food supplies
- Assisted diet office in entering patient meal orders into the system
- Assisted kitchen staff to maintain cleanliness and order in the kitchen
- Inspected equipment, refrigerators and warming lamps to check compliance with safe operating levels
- Restocked supplies and prepared additional ingredients during downtime for expected busy periods
- Plated hot meals and salads in aesthetically pleasing arrangements
- Circulated kitchen area to receive work assignments and identify support tasks
- Prevented food spoilage by monitoring dates, rotating stock and following proper storage procedures
- Strictly followed sanitation and food safety guidelines as required by regulatory agencies and company
- Scanned shelves and product cases for expired stock and discarded outdated or spoiled items
- Kept supplies in sufficient stock by assessing inventory levels and reporting lower stock items
Cashier
Target
11.2005 - 01.2006
- Computed sales prices, total purchases and processed payments
- Maintained knowledge or current promotions, policies regarding payment and exchanges and security practices
- Administered all point of sale opening and closing procedures
Waitress
Perkins Family Restaurant
02.2004 - 02.2005
- Consistently provided professional, friendly and engaging service
- Demonstrated genuine hospitality while greeting and establishing rapport with guests
- Skillfully promoted items on beverage lists and restaurant specials
- Followed all safety and sanitation policies when handling food and beverage to uphold proper health standards
- Displayed enthusiasm and knowledge about the restaurant's menu and products
Education
Bachelor of Science - Health Information Management
University of Arizona Global Campus
Chandler, AZ10.2023
GED - undefined
Great Falls Adult Education Center
Great Falls, MT01.2013
Skills
- Advanced computer skills
- Detail-oriented
- Customer interface expertise
- Superior organizational skills
- Exceptional workflow management
- Strong problem solving aptitude
- Proficiency with Microsoft Word and Excel
- Strong interpersonal skills
- Resourceful
- Staff management
- Document workflow
- Interpersonal and written communication
Websites, Portfolios, Profiles
www.linkedin.com/in/kayla-burns-6108601b2
Timeline
Claims Liaison
Centene Corporation
07.2024 - Current
Lead Claims Analyst
Centene Corporation
04.2023 - 07.2024
Senior Claims Support Analyst
Centene Corporation
11.2021 - 04.2023
Claims Analyst
Centene Corporation
08.2020 - 11.2021
Service Specialist II
CPSI
04.2020 - 02.2021
Hospital Biller/Collector
Great Falls Clinic
08.2017 - 04.2020
Hospital Government Biller/Collector
Benefis Health System
11.2014 - 08.2017
Patient Account Representative
Benefis Health System
09.2013 - 11.2014
Interim Kitchen Supervisor
Benefis Health System
01.2010 - 09.2013
Call Center Service Representative
Benefis Health System
05.2006 - 09.2013
Food Service Worker
Benefis Health System
05.2006 - 09.2013
Cashier
Target
11.2005 - 01.2006
Waitress
Perkins Family Restaurant
02.2004 - 02.2005
GED - undefined
Great Falls Adult Education Center
Bachelor of Science - Health Information Management
University of Arizona Global Campus
Similar Profiles
Heather PopeHeather Pope
Coding Analyst I at Centene CorporationCoding Analyst I at Centene Corporation
Tressie McLendonTressie McLendon
Direct to Consumer Inside Sales at Centene CorporationDirect to Consumer Inside Sales at Centene Corporation
Amber JimenezAmber Jimenez
Sr. Grievance Coordinator at Centene CorporationSr. Grievance Coordinator at Centene Corporation