Kelly Paulino
Lawrence,MA
Summary
Dedicated Billing Specialist with over five years of experience in patient billing and insurance claims. Expertise in quality assurance and problem-solving leads to improved accuracy and efficiency in billing processes.
Overview
12
12
years of professional experience
Work History
Billing Specialist
Greater Lowell Pediatrics
Lowell, Massachusetts
08.2023 - 12.2025
- Processed patient billing and insurance claims for pediatric services.
- Reviewed and verified patient information for accuracy and completeness.
- Communicated with insurance companies to resolve billing discrepancies.
- Maintained organized records of payments and patient accounts.
- Assisted patients with inquiries regarding bills and payment options.
- Educated patients on insurance benefits and coverage details.
- Answered customer inquiries regarding billings, payments, account status.
- Leveraged Epic EMR to enhance efficiency in patient data management and billing processes.
Billing Assistant
Conlins Pharmacy
Methuen, Massachusetts
02.2020 - 07.2023
- Daily review and confirmation of processed orders.
- Prepares and compiles all supporting medical documentation required for claim submission.
- Ensured quality assurance of billing documentation to uphold effective billing procedures and minimize errors.
- Initiated and maintained follow-up procedures for unpaid claims and denials, enhancing resolution efficiency.
- Applies and posts cash receipts to outstanding balances.
- Conducted weekly collection calls to customers on private-pay balances, improving payment recovery rates.
- Provides back-up operator telephone coverage when needed.
- Compiles data for monthly reporting as required by management.
- Provides assistance in gathering carrier allowable via insurance fee schedules.
- Communicates reimbursement information and coverage criteria to appropriate personnel within the organization.
- Communicates information systems changes, updates and enhancements to appropriate personnel in the organization.
- Performed diverse tasks and completed special projects to support the Billing Manager's objectives.
Account Resolution Specialist
PRL
Merrimack, New Hampshire
12.2018 - 01.2020
- Working daily queues
- Appeals
- Facilitated resubmissions to enhance claim accuracy
- Identified denial trends and implemented strategies to reduce/eliminate denials
- Maintain performance and quality measures
- Resolved A/R issues in real time
- Aging AR Reports
Collections Specialist
Compass Group
Salem, New Hampshire
06.2018 - 09.2018
- Followed up on pending claims, facilitating timely processing and resolution
- Ability to prioritize collection activity to avoid write-off exposure
- Reviews and processes Insurance EOBs, denials and rejected claims
- Ability to respond to denials and file appeals in a timely manner
- Contacted third-party payers to obtain current account status, enhancing payment tracking
- Determines actions necessary to obtain prompt third party payments
- Makes appropriate and necessary corrections to patient account information as needed to ensure timely payment
- Accurately records and communicates patient information
- Supported team objectives by assisting with additional collection duties as needed
Billing Specialist
LogixHealth
Bedford, Massachusetts
04.2017 - 06.2018
- Review denials on explanation of benefits (EOB) statement and work issues until resolved
- Processed appeals for claims requiring additional review, ensuring timely resolution
- Submit any required documentation on insurance companies as requested
- Research the claims for information in order to process bills in a timely manner
- Corrected errors and resubmitted unprocessed or returned claims, facilitating prompt reimbursement
- Audited new and existing employee work for accuracy, enhancing overall quality assurance
- Assisted other departments with various tasks
Billing Clerk
Middletton Family Medicine
Middleton, Massachusetts
11.2015 - 02.2017
- Review charges for accuracy for multi-clinician practice and on site lab
- Managed receivables through coordination with Athena Net and billing staff to ensure accurate financial tracking.
- Educate Clinicians on coding and effective charging for maximum reimbursement
- Work with registration staff and phone staff to obtain accurate information
- Handle all aspects of billing for physicians and nurse practitioners, including coding, charge entry, system management
- Resolved problematic billing and re-certification issues by collaborating with provider service representatives across all payers.
- Oversaw coding and billing functions for seven physician groups, including internal medicine, ensuring compliance and accuracy.
Billing Representative
AdvanEdge Healthcare Solutions
Salem, New Hampshire
06.2014 - 11.2015
- Ensure timely processing of exceptions for charges, payments and rejections.
- Processed data entries accurately and promptly to maintain billing integrity.
- Correct all data entry exceptions dropped to paper within one week of notification.
- Reference all available resources, including client profiles, for accurate billing.
- Notified Billing Supervisor of variances and potential issues to prevent processing delays.
- Evaluated processes and procedures regularly to identify areas for improvement.
- Maintain a cohesive working relationship with staff and management and working as a team to achieve optimal efficiency.
- Assumed additional responsibilities to support overall operations.
Education
Certificate - Medical Office Billing & Coding
Lincoln Tech
Lowell, MA12-2013
High School Diploma -
Greater Lawrence Technical High School
North Andover, MA06-2009
Skills
- Patient billing
- Insurance claims
- Claims processing
- Claim submission
- Claim processing
- Payment posting
- Cash posting
- Revenue cycle management
- Epic EMR
- Billing software proficiency
- Billing software
- Quality assurance
- HIPAA compliance
- Insurance confirmation
- Claims resolution
- Dispute resolution
- Customer relationship management
- Customer service
- Customer engagement
- Attention to detail
- Process improvement
- Problem solving
- Multitasking
- Time management
- Data entry proficiency
- Team collaboration
- Teamwork
- Conflict resolution
- Relationship building
- Team collaboration
- Teamwork
Languages
Spanish
Native/ Bilingual
Timeline
Billing Specialist
Greater Lowell Pediatrics
08.2023 - 12.2025
Billing Assistant
Conlins Pharmacy
02.2020 - 07.2023
Account Resolution Specialist
PRL
12.2018 - 01.2020
Collections Specialist
Compass Group
06.2018 - 09.2018
Billing Specialist
LogixHealth
04.2017 - 06.2018
Billing Clerk
Middletton Family Medicine
11.2015 - 02.2017
Billing Representative
AdvanEdge Healthcare Solutions
06.2014 - 11.2015
Certificate - Medical Office Billing & Coding
Lincoln Tech
High School Diploma -
Greater Lawrence Technical High School