KIMBERLY ALLEN

As an Account Representative II, I am responsible for billing insurance and insurance collections and denial management in a timely manner. Review electronic claims and submission for accuracy and examine contracts for correct reimbursement. Resubmits rejected claims and resolve accounts for errors. Work with insurance companies for accurate billing, collections, corrections of denials and status of payments. Reviews accounts for overpayments and underpayments and apply insurance refunds as requested.

• Works with Insurance payers to ensure proper billing, collections, or denial management on patient accounts and expedite resolution of accounts.
• Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved. Produces written correspondence to payors and patients regarding status of claim, requesting additional information.
• Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account. Initiates next billing, follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate. Sends initial or secondary bills to Insurance companies.
• Documents billing, denials and/or collection step(s) that are taken and all measures to resolve assigned accounts. Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims
• Process refunds accurately from requests and spreadsheets and determine if refund is due and amount being requested is correct.

• Company Overview: Care Connection can be defined as a sequence of events intended to smoothly pilot our patients through a complex health care system
• Care Connection provides our patients with the assistance to ensure they receive the appropriate continuation of care after a hospital or emergency department (ED) visit
• Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified
• Performs skills necessary to create a high-quality patient experience, as reflected through acceptable satisfaction scores, quality monitoring, and patient feedback
• Copies, scans, files, and distributes documents
• Documents activities and progress in the electronic medical record per defined policy and procedures, computer billing/utilization systems, or in other ways as directed
• Inputs clinical information and discharge planning details into the medical record as appropriate for the role
• Keeps RN Care Manager, Social Worker and/or other members of clinical team informed of issues or delays impacting a timely discharge or scheduling of post-acute appointments
• Prepares documents and reports required data for clinical reviews and discharge plans for third-party payers and other internal and/or external groups
• Contacts third-party payers to obtain and/or confirm authorization for services and communicates necessary related clinical information, when required
• Assist in the completion and maintenance of care management contracts during and after patient’s hospitalization
• Ensures all contract information is accurately documented and maintained in patients’ medical record
• Thoroughly researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards
• Escalates issues as appropriate
• Performs other duties as assigned
• Care Connection can be defined as a sequence of events intended to smoothly pilot our patients through a complex health care system
• Care Connection provides our patients with the assistance to ensure they receive the appropriate continuation of care after a hospital or emergency department (ED) visit

• Serves as primary point of contact for all agency staff, providing exemplary customer service and facilitates communication between AdventHealth Revenue Cycle and all Business Partners, timely and appropriately
• Coordinates research with internal and external departments to ensure resolution on Bad Debt/Early Out account escalations and recalls
• Communicates with departments in a professional and courteous manner ensuring accurate details and information are provided
• Examines and stays abreast of changes in agency contracts
• Receives invoices monthly for payment directly from agencies
• Ensures invoicing from agencies are accurate prior to AdventHealth’s payment and facilitates payments as determined through agreements and aligned with account reconciliation reports
• Analyzes an account exception report, to determine cause of any failed patient account transfers to collections
• Takes appropriate actions to ensure the accounts are scheduled to transfer in next and appropriate billing cycle
• Creates reports and performs weekly audit to track accounts with agencies are billed to insurance within timelines set by contracts and agreements
• Educates PA/PFS team of inconsistencies in processing
• Works closely with AH AIT, Business Analytics, and PA/PFS Systems Support to ensure appropriate inventory placement and reporting on a regular basis
• Troubleshoot file and vendor access issues
• Analyzes accounts daily to apply fees, apply flags, work with Ins Reimbursement team for accurate payor billing, and/or recall accounts as necessary
• Analyzes error trends, statistics, and shares outcomes with leadership
• Follows up on correspondence to appropriately work patient accounts, ensure recalls are appropriate for account, and correlate and mail agency bills
• Assists PA/PFS with patient or account concerns/questions to ensure prompt and accurate resolution is achieved
• Produces written correspondence to agencies and patients regarding status of account, requesting additional information, etc
• Acts as a liaison between the Revenue Cycle and external Business Partners with an objective point of view ensuring the most appropriate resolution for the patient and for AdventHealth
• Participates in agency phone calls or meetings to discuss issues or processes
• Identify trends and opportunities for operational changes to reduce unnecessary concerns and advises leadership often
• Actively understands AH PA/PFS insurance reimbursement and registration processes
• Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account
• Initiates next billing, followup and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate
• Documents billing, follow-up and/or collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor/Manager if necessary
• Checks Medicaid eligibility in appropriate eligibility system
• If eligible, provides the insurance information to Patient Financial Services timely and within guidelines set by Revenue Cycle
• Completes other duties assigned by Supervisor/Manager
• Maintains accuracy and volume as outlined in associated Audit Plan, established by Revenue Cycle
• Provides exemplary customer service to patients, families, coworkers, and external customers
• Adheres to compliance and security regulations including HIPAA by accessing and releasing PHI as minimally necessary to perform duties and according to procedures

• Under general processes, 'Attorney requests for billing statements' timely, within guidelines set by Leadership
• Recalls Bankruptcy and expired patient filings from agencies and processes claims, timely, within guidelines set by Leadership
• Processes, 'Attorney requests for billing statements' timely received not limited to mail, email, and fax, within guidelines set by Revenue Cycle
• Recalls Bankruptcy filings from agencies and processes claims, timely, within guidelines set by Revenue Cycle
• Recalls and processes expired charity to perform probate verification and write off of balance timely within guidelines set by Revenue Cycle
• Routes open Probate case information to appropriate legal counsel for filing of claims
• Processes all notice of representation advisories timely within guidelines set by Revenue Cycle
• Provides insurance information to Patient Financial Services as received by firm representing patients in a timely within guidelines set by Revenue Cycle

• Specialty coordinator/ CSR for all dental specialists, outside sales and special projects
• Responsible for product recon, processing orders, pulling and fulfilling orders from the warehouse, updating the order templates, inventory control, corresponding with doctors and staff, researching items unavailable through regular vendors during shortages or backorders, start up orders and all other administrative duties as needed
• Strong focus on attention to detail and superb follow up skills, Maintain exceptional oral and written communications skills as well extreme organizational skills
• Ability to adapt to rapid change and multitasking

• As the office manager of multi-specialty and 3 doctor practice I was responsible for overseeing all of the daily operations within the practice
• This included on boarding new doctors and staff, maintaining a productive schedule, creating job descriptions, credentialing, payroll, time off requests and all other requests to make the office run efficiently
• Filled in for the front and back office as needed as a leader and mentor
• Trained employees on OSHA and HIPPA and general standard of care
• Answering multiline phone system, entering patient demographics into cloud-based software (EMR), scheduling appointments, checking in and checking out patients, collecting copays
• Presenting treatment plans, explaining financials including insurance and patent benefits and financial responsibilities
• Verifying patients’ insurance benefits/ breakdown by phone or online
• Processing insurance claims via electronic and paper submissions, sending attachments and notes as needed for additional payments
• Posting insurance and patients payments, adjusting balances for contracted payors
• Collecting on balances and explanation of dental benefits to patients
• Running end of day reports, balancing financials, and bank deposits
• Coordination of dental surgeries with local hospitals, including scheduling, submitting insurance for prior authorizations, explaining benefits and payments to patients, and going over procedures and instructions
• Handling any complaints by doctors, staff, or patients with the end goal of resolving all situations proactively
• Also, as an Expanded Functions Dental Assistant, I would assist with patient exams, cleanings, and x-rays
• I was also credentialed to work in the OR at local hospitals where patients were sedated for dental surgeries
• Responsible for correct count of dental instruments and supplies used, monitor patients for any medical issues during treatment, explaining post treatment protocols and treatment completed

• Oversee the daily activities of the office for multiple doctors that rotated seeing patients in the office
• Maintain a full and productive schedule for each doctor and make sure office is staffed properly for the daily patient load
• Insurance verification, pre authorizations, posting patient and insurance payments
• Submitting insurance claims for medical and dental insurance for dental procedures
• Reconciliation of payments and disputes

• As the administrative assistant/ Office Coordinator, I was the first impression of the office
• I would greet patients upon arrival with an upbeat and friendly attitude, as well as at the time of the initial phone call
• I was responsible for maintaining all of the front office duties such as answering the phones, scheduling appointments, collecting patient demographics and insurance information, presenting treatment plans, setting up payment arrangements, verification of insurance, authorizations for treatment, submitting claims, posting payments and all other duties as asked by the doctor
• Volunteering at community events to promote the practice and be involved with the locals