Summary
Overview
Work History
Skills
Timeline
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Kenneth M. Lenorr

Chicago,IL

Summary

Dynamic Senior Representative with a proven track record in claims adjudication and regulatory compliance. Achieved exceptional quality scores while spearheading process improvements and mentoring team members. Skilled in data analysis and collaboration, driving accuracy and efficiency in claims processing. Passionate about enhancing operational excellence in healthcare.

Overview

13
13
years of professional experience

Work History

BPO Senior Representative

NTT Data
Plano, TX
09.2024 - Current
  • Prioritized tasks and adjudicated claims according to turnaround times and service level agreements.
  • Ensured compliance with client-defined workflows and guidelines during claim adjudication.
  • Maintained quality scores above 98.5% for provider accuracy and 99.75% for financial accuracy.
  • Resolved high-priority email claims promptly, adhering to set timelines.
  • Calculated payable amounts using standardized methodologies and fee schedules accurately.
  • Audited provider data and claims systems for regulatory compliance.
  • Processed credentialing applications in alignment with governmental and payer standards.

Claims Lead Representative

Cigna Healthcare
Irving, TX
12.2022 - 08.2024
  • Analyzed medical claims to ensure pricing accuracy and provider contract compliance.
  • Collaborated with provider contracting teams to identify and resolve system errors.
  • Maintained audit compliance through adherence to claim review protocols.
  • Spearheaded initiatives to improve claim accuracy and turnaround time.
  • Delivered training and mentorship to enhance skills of claims processing team members.

Claims Auditor

Oneshare Health
Irving, TX
02.2020 - 11.2022
  • Conducted root cause analysis to identify and resolve claim misapplication issues.
  • Utilized Facets for tracking claims, optimizing workflows, and ensuring adjudication accuracy.
  • Audited Appeals & Grievances cases to ensure compliance with regulatory and internal guidelines.
  • Developed quality control protocols, enhancing claim accuracy and regulatory compliance.

Claims Adjudicator II

Evolent Health
Chicago, IL
12.2017 - 01.2020
  • Analyzed CMS-1500 and UB-04 claims for accuracy and compliance with Medicare/Medicaid regulations.
  • Processed claims for CountyCare of Illinois, MDwise of Indiana, and Medicare Advantage for BCBS.
  • Conducted pricing verification to ensure proper application of provider contracts.
  • Investigated overpayment and underpayment claims to initiate correction and recoupment.
  • Assisted in system enhancements to improve claim adjudication accuracy.

Claims Processor

Smart Med Corporation
Chicago, IL
01.2013 - 10.2017
  • Processed over 1,200 claims weekly, ensuring adherence to Medicare and Medicaid guidelines.
  • Conducted thorough claims verification and pricing applications for accurate reimbursements.
  • Resolved denied or rejected claims, enhancing provider payment turnaround.
  • Managed Medisoft database and performed claims data entry with precision.
  • Reviewed claim edits using Optum software to improve accuracy and compliance.

Skills

  • Data analysis and management
  • Claims adjudication
  • Regulatory compliance
  • Quality assurance
  • Data analysis
  • Software optimization
  • Process automation
  • Project management
  • Technical documentation
  • Collaboration and mentoring
  • Process improvement

Timeline

BPO Senior Representative

NTT Data
09.2024 - Current

Claims Lead Representative

Cigna Healthcare
12.2022 - 08.2024

Claims Auditor

Oneshare Health
02.2020 - 11.2022

Claims Adjudicator II

Evolent Health
12.2017 - 01.2020

Claims Processor

Smart Med Corporation
01.2013 - 10.2017

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Kenneth M. Lenorr