Kimberly Benoit
Cohoes,NY
Summary
With over 10 years of experience in the healthcare industry, I bring a wealth of knowledge across various Therapeutic Areas and Revenue Cycle. Throughout my career, I have held roles such as Field Access Manager and Manager of Patient Financial Services, allowing me to develop a deep understanding of payer reimbursement, authorizations, coding changes, and the claims submission/appeals processes. Providing exceptional customer service and support, and honing my skills in account maintenance, acute care/physician billing, specialty pharmacy, and navigating government and commercial insurance.
Overview
23
23
years of professional experience
Work History
Field Reimbursement Access Manager
Cencora
06.2022 - Current
- Provide face-to-face, personalized issue resolution.
- Educate providers offices on local and regional payer issues, coding changes, and appropriate claims submission processes.
- Review patient insurance benefits and validate prior authorization requirements.
- Provide educational support on formulary coverage, medical exception appeals, and state step therapy laws and appeals process.
- Medicare/Medicaid policy and coverage determinations.
- Extensive knowledge of medication access channels (e.g. Pharmacy/medical benefit including buy and bill and AOB).
- Liaison between Health Care professional office and Pharmacy Benefit Manager for pull-through.
- Identifying alternate funding/financial assistance programs.
- Coordinating with patient support service representatives to identify and educate healthcare professionals on benefit investigations and pull-through strategies.
- Collaborate with field support team members (sales representatives, key account managers) and serve as reimbursement expert for local team.
- Manage territory logistics, routing, and account business plan.
Prior Authorization/Insurance Billing Specialist
Upstate Gastroenterology Associates
06.2021 - 06.2022
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Verification of post payment in accordance with contract.
- Reduced turnaround time and established work flow for prior authorization requests by utilizing electronic submission methods.
- Quality assurance, monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Buy and Bill for various in office Sub Q injections.
- Minimized errors in claims submissions through regular cross-checking of CPT and ICD codes against medical documentation.
- Increased revenue collection by diligently pursuing outstanding claims and negotiating with insurance companies.
- Assisted patients in understanding their coverage benefits, providing clear explanations and addressing any concerns or questions.
Application Analyst II
Trinity Health - St. Peters Health Partners
05.2014 - 06.2021
- Analyze/implement hospital system program changes to 837I/837P electronic & paper billing claim forms.
- Provide support to leadership in analyzing data sets within receivables and implement workflow process, updates, or change.
- Support Billing systems update release, testing and implementation.
- Apply Medicaid APG billing methodologies to claim programs.
- Electronic processing of Capitation Payments
- Prepare NYS SPARC data submissions
- Analyze and PARSE NYS SPARC data errors
- Provide support and maintenance to Pharmacy department for 340B implementation and billing.
- Review pharmacy claims for appropriate modifier and waste line items for billing and insurance reimbursement.
- Analyze/maintain all coding/billing form programs to ensure compliant and accurate reimbursement from insurance.
- Supported daily operations and system maintenance procedures.
- Created manuals and training guidelines for staff education.
- Trained end-users on billing systems, facilitating a smooth transition during software rollouts and new hire academy.
- Maintained detailed documentation of application updates and changes to facilitate efficient troubleshooting processes when required.
- Managed multiple projects simultaneously, ensuring timely completion and adherence to established guidelines.
- Served as a liaison between technical teams and key stakeholders, ensuring clear communication of project goals while managing expectations effectively.
Manager Billing Physician Services
Seton Health System
10.2001 - 04.2014
- Responsible for various tasks associated to the management/direct reporting responsibilities of 12 Patient Account/Billing Associates.
- Management of physician A/R and collections of outstanding government and commercial insurances for 12 hospital based provider offices including Oncology and OB/GYN.
- Onboarded new employees with training and new hire documentation.
- Educational support and training on authorization and denial appeal procedures.
- Cross-trained existing employees to maximize team agility and performance. Providing education on commercial insurance billing policies, contracts, and regulations.
- Analyze Medicare/Medicaid government billing regulations and apply programming to Meditech billing software for accurate claim submission.
- Coverage and benefits inquiry determinations for facility and professional reimbursement.
- Collaborate with insurance representatives to correct and appeal coding error/denials.
- Stay current and active in monitoring Medicare and Medicaid policies and reimbursement methods.
- Maintain all billing claim forms for hospital APC/APG billing for UB04 and CMS 1500 billing forms.
- Managed and motivated employees to be productive and engaged in work.
Education
Paralegal Studies
Sage Junior College of Albany
AlbanyBachelor of Science - Health Administration
Capella University
Minneapolis, MN06.2026
Skills
- Verbal and written communication
- Medicare/Medicaid
- Customer Service
- Market Access/Reimbursement
- Pre/Post Payment evaluation
- Team Work/Collaboration
- Accounts receivable management
- Authorizations
- Medical terminology knowledge
- Billing Procedures
Accomplishments
2023 Commitment to Purpose
Recognized for outstanding work and demonstrating excellence in areas of follow through, commitment, and a positive attitude.
Timeline
Field Reimbursement Access Manager
Cencora
06.2022 - Current
Prior Authorization/Insurance Billing Specialist
Upstate Gastroenterology Associates
06.2021 - 06.2022
Application Analyst II
Trinity Health - St. Peters Health Partners
05.2014 - 06.2021
Manager Billing Physician Services
Seton Health System
10.2001 - 04.2014
Paralegal Studies
Sage Junior College of Albany
Bachelor of Science - Health Administration
Capella University
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