Kimberlin Rokov
St. Louis,MO
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Insurance Billing Specialist
Washington University in St. Louis
St. Louis, MO
11.2022 - 05.2024
- Facilitation of training for new Insurance Benefit Specialist
- Completed adjustment and charge corrections
- Obtained Prior authorization and Referrals
- Performed collection follow up for commercial insurance, managed care plans, Medicare and Self-Pay
- Identified trends in denied claims and worked with staff members to develop corrective action plans.
- Verify medical coverage and communicate benefit details to patients
- Submit appeals on denied claims
- Analyzed provider contracts and fee schedules to determine appropriate reimbursement rates for services provided by healthcare providers.
Medical Claims Reviewer
Medtech
St. Louis, MO
09.2021 - 11.2022
- Ensure correct coding and ICD-10 sequence
- Complete provider credentialing with insurance payers
- Appeal denials
- Obtain insurance benefits when needed
- Submit claims to insurance payers in a timely manner
Medical Coder
The Orthopedic Center of St. Louis
St. Louis, MO
12.2019 - 08.2021
- Key all tickets within 2 business days of receipt
- Follow up on any claim denials or underpay claims in effort to get claim processed and paid according to contract
- Dispatch statements and required documents to attorney offices to aid in legal proceedings.
- Reviewed Medical Policies for each plan to ensure department comprehension
- Monitored updates to Fee Schedules to guarantee claims were compensated in line with contractual agreements.
- Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
Account Representative
NextGen Healthcare
St. Louis, MO
07.2019 - 12.2019
- Reviewed and audited accounts for optometrist offices to determine status and appropriate action required
- Documented follow-up appropriately in practice management systems while researching and conducting follow-up on denials and requests for additional information, utilizing denial management reports and correspondence
- Identified, verified and documented account adjustments according to established policy and procedure
- Regularly worked with payers such as Medicare, Medicaid, and Commercial Insurance agencies, submitting medical claims for payment
- Reviewed remittance statements for rejected/denied claims and reprocess accordingly
- Ensured correct insurance authorization on file for provided services, made effort to obtain retro authorization if possible
REIMBURSEMENT SPECIALIST
FOUNDATION CARE
St. Louis, MO
10.2017 - 07.2019
- Verify insurance coverage and coverage levels, obtain all necessary insurance approvals
- Communicate Insurance coverage to patients prior to rendering services, including the initiation of pricing contracts to ensure reimbursement according to contract
- Write appeals when necessary while also working to identify effective work procedures and communicate suggested procedure changes to leadership and team members
- Negotiated pricing with insurance payors on non-covered specialty items while also securing single case agreements
ACCOUNT REPRESENTATIVE
INSIGHT GLOBAL
St. Louis, MO
03.2015 - 06.2017
- Followed up on insurance claims billed on UB 92 and CMS 1500 forms for private/government payers and ensured that claims were processed and followed up on in timely manner
- Documented follow-up appropriately in practice management systems
- Reviewed and audited accounts to determine status and appropriate action required from work lists
- Collaborated with management to identify payer trends and non-payment issues
PHARMACY TECHNICIAN
EXPRESS SCRIPTS
10.2011 - 03.2015
- Assisted supervisor and team lead with administrative duties
- Contacted prescribers for medication refills and to complete insurance authorization requests
- Provided teammates with daily metrics
- Provided support to management with administrative duties
SURGICAL SCHEDULER
MIDWEST PODIATRY
10.2007 - 10.2011
- Ensured accuracy in assigning CPT and ICD-9 codes to patient accounts
- Transferred dictated notes into EMR system
- Resolved escalated issues regarding Workman's Compensation and disability
- Communicated efficiently with insurance payers in effort to obtain payment on denied claims through the process of appeal
- Scheduled outpatient procedures for a practice of 5 physicians
- Posted payments and Charges to patient accounts
Education
Certification - Medical Coding
AAPC
07.2024
CERTIFICATION - MEDICAL BILLING and CODING CERTIFICATION
EVEREST COLLEGE
Skills
- BILLING
- DME
- Medical Coding
- Medical Billing
- Medical Insurance
- CPT Coding
- ICD-10
- Medical Records
- EMR Systems
- Insurance Verification
- Medical Terminology
- Epic
- Transcription
- Anatomy Knowledge
- Data Entry
- HIPAA
- Patient Care
- Credentialing
- Communication skills
- HCPCS
Certification
Medical Billing Certification
Additional Information
I have extensive experience in secondary billing, Appeals writing, Insurance follow up, and benefit verification. I also obtained prior authorizations and negotiated rates for claim reimbursement.
Personal Information
Title: MedicalBiller- Insurance Follow up
Timeline
Insurance Billing Specialist
Washington University in St. Louis
11.2022 - 05.2024
Medical Claims Reviewer
Medtech
09.2021 - 11.2022
Medical Coder
The Orthopedic Center of St. Louis
12.2019 - 08.2021
Account Representative
NextGen Healthcare
07.2019 - 12.2019
REIMBURSEMENT SPECIALIST
FOUNDATION CARE
10.2017 - 07.2019
ACCOUNT REPRESENTATIVE
INSIGHT GLOBAL
03.2015 - 06.2017
PHARMACY TECHNICIAN
EXPRESS SCRIPTS
10.2011 - 03.2015
SURGICAL SCHEDULER
MIDWEST PODIATRY
10.2007 - 10.2011
Certification - Medical Coding
AAPC
CERTIFICATION - MEDICAL BILLING and CODING CERTIFICATION
EVEREST COLLEGE
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