Kimberly Alston
Somerset,USA
Summary
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
15
15
years of professional experience
Work History
Patient Account Representative
Public Partnerships, PPL
06.2024 - Current
- Facilitate communication among patients, families, and providers to ensure coordinated care plans and progress.
- Monitor patient outcomes regularly and update care plans according to treatment effectiveness and changing needs.
- Address participant and caregiver inquiries, delivering clear solutions to service-related issues and program policy concerns.
- Clarify program guidelines and policies to enable participants to make informed decisions about care and support.
- Guided caregivers in submitting timesheets through Time4Care, ensuring compliance with accurate payroll documentation.
- Address participant and caregiver inquiries, delivering clear solutions to service-related issues and program policy concerns.
- Developed communication strategies to enhance patient engagement and satisfaction.
- Coordinated and scheduled meetings and appointments.
Health Claims Specialist
East Orange General Hospital
11.2022 - 05.2024
- Reviewed submitted health claims for completeness and accuracy, ensuring strict adherence to compliance regulations.
- Verified patient eligibility for insurance coverage efficiently to reduce claim denials and processing delays.
- Resolved provider disputes regarding denied or delayed claims by applying thorough knowledge of policies.
- Analyzed health data to identify trends and guide strategic planning initiatives.
- Processed complex reimbursement claims, ensuring compliance with federal and state regulations.
- Analyze customer feedback data and collaborated with my team to implement process changes,leading to 25% decrease in patient complaints.
- Evaluated insurance policies to maximize reimbursement efficiency and minimize claim denials.
Patient Account Representative
Allies Assisted Living
09.2010 - 02.2022
- Coordinated communication with finance, accounting, IT, and HR teams to support smooth interdepartmental processes.
- Initiated collection activities for overdue accounts while maintaining compliance with HIPAA regulations and ethical standards.
- Resolved patient billing inquiries promptly by providing accurate account information and clear payment instructions.
- Analyzed claim denials thoroughly to identify reimbursement solutions from insurance companies and third-party payers.
- Verified the accuracy of medical coding to ensure correct billing and appropriate reimbursement for provided services.
- Completed monthly reconciliations of patient accounts to maintain accuracy in facility financial reporting.
- Developed strong relationships with key contacts at insurance companies to expedite the resolution of claim disputes or other account-related issues.
Education
BBA - Business Administration and Management
Strayer University
Piscataway, NJ03.2025
Skills
- Case Management
- Patient Advocacy
- Care Coordination
- Time Management
- Problem Solving
- Teamwork and Collaboration
- Customer Service
- Communication Skill
- Patient Education
- Policy Compliance
- HIPAA Knowledge
Timeline
Patient Account Representative
Public Partnerships, PPL
06.2024 - Current
Health Claims Specialist
East Orange General Hospital
11.2022 - 05.2024
Patient Account Representative
Allies Assisted Living
09.2010 - 02.2022
BBA - Business Administration and Management
Strayer University