Kelly Sexton
Darlington,SC
Summary
Dynamic Revenue Cycle Associate with proven expertise in RARC and ICD-10 coding. Adept at claims resolution and enhancing revenue cycle efficiency through effective communication and team collaboration. Recognized for optimizing billing processes and ensuring compliance with Medicare regulations, driving timely payments and improved financial outcomes.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Revenue Cycle Associate
Aspirion
06.2023 - 12.2025
- Demonstrated proficiency in RARC, CARC, ICD-9, and ICD-10 codes.
- Interpreted medical records, forms, and prior authorizations accurately.
- Utilized Epic, Collect Compass, and spreadsheets for thorough third-party billing and claims review, ensuring accurate processing.
- Ensured compliance with government payer policies and regulations.
- Analyzed and resolved denied or rejected claims for relevant payers.
- Interpreted remittances, bulletins, fee schedules, and other key information.
- Conducted outbound and inbound calls to insurers, effectively resolving denials and improving claims outcomes.
- Collaborated with departments on coding, authorizations, and payment posting to streamline revenue cycle processes.
Revenue Cycle Associate
Lexington Medical Center
07.2020 - 05.2023
- Government A/R follow up for Medicare, Medicaid, Medicare Advantage Plans, and Medicaid Managed Care plans, Responsible for compliance with applicable government payer policies, guidelines and regulations.
- Facilitated prompt submission of primary and secondary claims, ensuring timely payments and reducing aged days in accounts receivable.
- Researched, analyzed and resolved denied, rejected or edited claims for applicable payers, enhancing claims processing accuracy.
- Managed payment postings and submitted corrected claims to adjust payer requests.
- Accurately update patient registration with correct insurance information, and update filing order for appropriate billing sequence.
- Contacted payers and insurers to resolve claims and clarify coordination of benefits.
- Collections follow up utilizing work queues for multiple specialties, including, OBGYN, Rural Health Clinic, Neurology, Pain Management, Radiology, inpatient and outpatient Hospitalists, Infectious Disease, Behavioral Health, Psychiatry, Occupational and Physical Therapy, and Family Practices.
- Accurately interpret remittances, payer bulletins or advisories, fee schedules and other pertinent information.
EPIC Project Analyst
Strong Memorial Hospital
Rochester, New York
08.2018 - 04.2020
- Analyzed data across roles using Excel pivot tables and charting techniques to support decision-making.
- Evaluated effectiveness of existing methods based on system logic and recommended process changes.
- Collaborated with ISD to initiate system optimization aligned with established workflows.
- Refined processes for professional-based billing in organ transplant and donor billing, reporting findings to leadership.
- Authored procedure manual for resolute professional billing covering all aspects of transplant and donor billing.
- Coordinated transfers of posting offsets and refunds between accounts to ensure accurate financial records.
- Trained users on role-specific functions and created tips for end users to enhance post-analysis performance.
- Assisted hospital HIPAA analyst in identifying registration and insurance billing errors as compliance coordinator.
Charge Entry Charge Review Team Lead
Strong Memorial Hospital
02.2018 - 08.2018
- Streamlined daily operations for charge entry and charge router review team, improving workflow and reducing processing time.
- Centralized billing operations for MFGBO, resulting in improved operational consistency and reduced redundancy.
- Developed and maintained desk procedures for multiple billing departments, including geriatrics and pediatrics.
- Coordinated candidate interviews and implemented training programs for new hires, fostering team integration and skill development.
Insurance Collection Specialist
Strong Memorial Hospital
08.2011 - 02.2018
- Maintained compliance with payer policies, guidelines, and regulations through proactive communication with insurers.
- Resolved denied or rejected claims through thorough research and analysis, improving reimbursement outcomes.
- Analyzed accounts to determine appropriate resolutions and actions.
- Executed charge entry for inpatient and outpatient ultrasounds and NSTs, ensuring accuracy and compliance.
- Interpreted remittance advice, payer bulletins, fee schedules, and relevant information accurately.
- Achieved defined productivity levels aligned with critical elements of the role.
- Managed OB/GYN billing processes to ensure accuracy and compliance.
- Collaborated with satellite offices to maintain efficiency in charge entry operations.
Financial Counselor
Strong Memorial Hospital
07.2010 - 08.2011
- Educated patients on insurance benefits and financial options to enhance understanding and decision-making.
- Guided patients in selecting payment plans and financial assistance programs to improve affordability and access to care.
- Provided financial counseling to clients on budgeting, credit management, and debt repayment strategies.
- Connected uninsured patients with necessary resources, services, and assistance to support their healthcare needs.
- Supported patients in completing necessary financial paperwork and applications.
- Reviewed patient accounts for accuracy and completeness of information.
- Maintained confidentiality while handling sensitive financial information.
- Responded to patient inquiries in the call center.
Secretary III
University of Rochester
12.2008 - 07.2010
- MFGBO, Central Support
- Managed scheduling for faculty meetings and departmental events.
- Organized and maintained confidential student and staff records.
- Coordinated communication between departments and external stakeholders.
Administrative Assistant Global Purchasing-Contract Employee
Delphi Corporation
03.2002 - 12.2008
Education
High School Diploma -
Hilton Central High School
Hilton, NY06-1993
Skills
- ICD-10 coding
- Medicare compliance
- Claims resolution
- Third-party billing
- Revenue management
- Epic software proficiency
- Billing inquiries
- Data analysis
- Workflow optimization
- Microsoft Office suite
- Project coordination
- Team collaboration
- Effective communication
- Oral communication skills
- Training design
- Customer service excellence
Certification
- Certified Professional Coder-A
Timeline
Revenue Cycle Associate
Aspirion
06.2023 - 12.2025
Revenue Cycle Associate
Lexington Medical Center
07.2020 - 05.2023
EPIC Project Analyst
Strong Memorial Hospital
08.2018 - 04.2020
Charge Entry Charge Review Team Lead
Strong Memorial Hospital
02.2018 - 08.2018
Insurance Collection Specialist
Strong Memorial Hospital
08.2011 - 02.2018
Financial Counselor
Strong Memorial Hospital
07.2010 - 08.2011
Secretary III
University of Rochester
12.2008 - 07.2010
Administrative Assistant Global Purchasing-Contract Employee
Delphi Corporation
03.2002 - 12.2008
High School Diploma -
Hilton Central High School