Kimberly Bacon
Lake Wales
Summary
Highly-motivated, resourceful, and dedicated professional with the desire to take on new challenges.
Strong work ethic, problem-solving ability, proactive attitude, and adept at working effectively unsupervised and in a team setting.
Eager to contribute to a dynamic team and support organizational goals, while mastering new skills enhancing the organizational brand.
Known for high productivity and passionate about continuous learning and professional development.
Overview
23
23
years of professional experience
Work History
Payment Resolution Specialist
Trinity Health
Livonia
03.2023 - Current
- Hospital patient accounts review and research of paid claims for Commercial and to identify variances, underpayments, overpayments, credit balances, root cause, analyze payer contracts/fee schedules, submit disputes/appeals, request adjustments, escalate payer trends and issues, request internal system issue corrections, coordinating with departments within the Revenue Cycle, collaborated with colleagues to find account resolution, knowledge of HCPCS, CPT, DRG, and ICD 10
Denials Representative
UF Health Central Florida
Leesburg
06.2016 - 12.2022
- Company Overview: previously Central Florida Health
- Hospital patient accounts review and research of claims for non-payment/underpayment due to insurance denial, review claim denials for root cause and any opportunities to appeal insurance company’s decision based on policy and procedure, work with internal departments to correct coding/utilization review/billing issues, track denial trends by payer, knowledge of insurance contracts and their respective timely filing limits by facility, insurance verification, aging denial reports, resolve payment variances, manual and electronic patient medical records, insurance, and miscellaneous payment posting, ERA EDI enrollment, knowledge of HCPCS, CPT, and ICD 9 and 10 codes, charge entry
- Previously Central Florida Health
Refund Specialist
Kelly Services
Leesburg
11.2015 - 06.2016
- Hospital patient accounts review for credit balance, prepare documents for refund issuance, applied and corrected adjustments to balance accounts, manual and electronic patient, insurance, and miscellaneous payment posting, insurance verification, claims resolution, aging reports, resolve payment variances, review of APR_DRG rate application to claims, knowledge of HCPCS, CPT, and ICD 9 and 10 codes
Accounts Payable Manager/Compliance Officer
Senior Medical Supplies
Longwood
07.2015 - 10.2015
- Durable Medical Equipment audits, collections, and billing, requesting and reading medical and supplier records, payment posting and adjustments, educating peers and co-workers, electronic and paper claim submission, keyed vendor invoices, setup recurring expenses, check runs, credit card payment, verify purchase orders with inventory department, assist patients and physician offices in meeting and maintaining insurance company’s eligibility requirements, insurance verification, working denials, aging reports, patient complaints, quality assurance, issued refunds, knowledge of medical equipment and supplies and their appropriate uses, knowledge of insurance contracts, obtain new insurance contracts, knowledge of federal, state, and local regulations, knowledge of HCPCS and ICD 9 and 10 codes
Reimbursement Specialist
Express Scripts Inc
Lake Mary
07.2013 - 07.2015
- Pharmaceutical test claim adjudication, requesting and reading medical and supplier records to submit for prior authorization, distributing prescriptions to Specialty Pharmacy, assist patient with copay assistance, assist patients and physician offices in meeting and maintaining insurance company’s eligibility requirements, insurance verification, working denied authorizations, quality assurance, internal auditing, worked with leads, supervisors, management, and the external client to improve the quality of workflow, knowledge of medication and its appropriate uses, knowledge of insurance policies, knowledge of federal, state, and local regulations, knowledge of HCPCS and ICD 9 and codes
Billing Manager
Florida Hospital Respiratory & Equipment
Longwood
07.2012 - 07.2013
- Durable Medical Equipment collections and billing, requesting and reading medical and supplier records, CMN follow-up, payment posting, educating peers and co-workers, medical claims entry and electronic and paper claim submission, confirming sales orders, generating invoices, verifying inventory, assist patients and physician offices in meeting and maintaining insurance company’s eligibility requirements, data entry, insurance verification, working denials, aging reports, and on hold reports, patient phone calls, refunds, knowledge of medical equipment and supplies and their appropriate uses, knowledge of Medicare, United Healthcare, Florida Medicaid, Medigap policies, and other Commercial Payers, Medicare and Medicaid HMO’s, and most major Private Insurances rules and regulations, knowledge of insurance contracts, knowledge of HIPPA, knowledge of federal, state, and local regulations, knowledge of HCPCS and ICD 9 codes
Admission’s Supervisor
Accounting Principles
Orlando
04.2012 - 07.2012
- Supervised Dialysis admission’s department, provided training and educational materials to staff, reviewed staffs daily work for Quality Assurance, data entry, insurance verification, obtained benefits and notification/authorization, $2 million refund project, knowledge of dialysis equipment and medication, setup insurance profiles in database, End-Stage Renal Disease coordination of benefits, knowledge of insurance contracts, knowledge of HIPPA, knowledge of ICD 9 codes, month-end procedures
Medical Review Manager
AeroCare Holdings Inc
Orlando
08.2007 - 04.2012
- Durable Medical Equipment development and management of Medical Review Department, management of front desk personnel, requested and read medical and supplier records needed to complete Medicare appeals and audits in a timely manner (required some travel), collaborated companywide internal billing and service procedures with Director of Reimbursement and Vice President of Administration, addressed compliance issues (required traveling), educated peers and co-workers (required some travel), interviewed, hired, and trained staff, built partnerships with staffing agencies, submitted internal and external payroll, conducted in-services, attended and spoke at manager meeting, reviewed records for acquisitions (required travel), medical billing, medical claims entry and submission, data entry, insurance verification, worked denials, A/R up to $1,000,000, collections up to $225,000 per month, patient statements, refunds, electronic and paper claims, knowledge of Medicare appeals process, knowledge of medical equipment and supplies and their appropriate uses, knowledge of Florida and Georgia Medicaid and Blue Cross, Medicare and Medicare HMO’s, and most major Private Insurances rules and regulations, knowledge of insurance contracts, knowledge of HIPPA, knowledge of federal, state, and local regulations, knowledge of HCPCS and ICD 9 codes, retro authorizations, and meet growth and financial goals; 4 promotions in 3 years
Central Scheduler
West Orange Healthcare District
Ocoee
01.2006 - 07.2007
- Incoming call center, schedule and pre-register patients for outpatient radiology and surgical procedures, customer service, insurance verification, quality control, and knowledge of CPT and ICD 9 codes
Document Scanner
SourceCorp @ORMC
Orlando
10.2005 - 01.2006
- Prepare, scan, and index medical records for eight Orlando Regional Hospitals
Central Scheduler
Lake Wales Medical Center
Lake Wales
11.2003 - 10.2005
- Incoming call center, schedule patients for outpatient radiology and surgical procedures, pre-register and register patients for outpatient and ER services, provide customer service, insurance verification, obtain authorization, patient collection, PBX operator, quality control, and knowledge of CPT and ICD 9 codes
Receptionist
McKinley & Chambers, P.A.
Lake Wales
08.2002 - 04.2004
- Schedule consultations for two branch offices, data entry of attorney’s timesheets, prepare client statements, incoming and outgoing mail, drafting fee agreements, revised legal documents, order office supplies
Education
Bachelor of Science - Accounting
University of Central Florida
05.2010
High School -
Lake Wales High School
05.2003
Skills
- Payment posting
- Insurance verification
- Denial management
- Appeal submissions
- Revenue cycle
- Customer service
- Data entry
- Communication skills
- Regulatory compliance
- Trend analysis
- Professional ethics
- Teamwork and collaboration
- Task prioritization
- Problem-solving abilities
- Attention to detail
- Multitasking capacity
- Self motivation
- Adaptability
Timeline
Payment Resolution Specialist
Trinity Health
03.2023 - Current
Denials Representative
UF Health Central Florida
06.2016 - 12.2022
Refund Specialist
Kelly Services
11.2015 - 06.2016
Accounts Payable Manager/Compliance Officer
Senior Medical Supplies
07.2015 - 10.2015
Reimbursement Specialist
Express Scripts Inc
07.2013 - 07.2015
Billing Manager
Florida Hospital Respiratory & Equipment
07.2012 - 07.2013
Admission’s Supervisor
Accounting Principles
04.2012 - 07.2012
Medical Review Manager
AeroCare Holdings Inc
08.2007 - 04.2012
Central Scheduler
West Orange Healthcare District
01.2006 - 07.2007
Document Scanner
SourceCorp @ORMC
10.2005 - 01.2006
Central Scheduler
Lake Wales Medical Center
11.2003 - 10.2005
Receptionist
McKinley & Chambers, P.A.
08.2002 - 04.2004
Bachelor of Science - Accounting
University of Central Florida
High School -
Lake Wales High School
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