Kimberly B. Ray
Wilmot,AR
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. Recognized as an Insurance Verification Specialist, adept at handling various office tasks. Committed to providing courteous, prompt, detailed, and accurate support as a Professional Call Center Customer Service Representative. Skilled in managing outbound and inbound calls, and adept at handling emergency issues with patience and tact. Effective Medical Claims Processor with a strong background in building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
7
7
years of professional experience
Work History
Insurance Verification Specialist
WellCare
Remote
02.2022 - Current
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
Claims Processing Specialist
First Choice
Remote
03.2020 - 02.2022
- Identified potential fraudulent claims through careful analysis of trends, patterns, and inconsistencies.
- Enhanced customer satisfaction with timely claim resolution through effective communication and followup.
- Streamlined the appeals process for denied claims, resulting in faster resolution times for clients.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
Healthcare Customer Service Representative
Humana
Remote
01.2018 - 03.2020
- Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Responded to customer requests for products, services, and company information.
Education
Associate Degree - Health Information Technology
University of Arkansas at Monticello
06.2018
High School Graduate -
Hamburg High School
05.2006
Skills
- Attention to detail
- Patient confidentiality
- HIPAA compliance
- Insurance coverage verification
- Critical Thinking
- Multitasking
- Attention to Detail
- Customer Service
- Active Listening
- Problem Solving
- Phone and Email Etiquette
- Computer Skills
- Verbal and Written Communication
Timeline
Insurance Verification Specialist
WellCare
02.2022 - Current
Claims Processing Specialist
First Choice
03.2020 - 02.2022
Healthcare Customer Service Representative
Humana
01.2018 - 03.2020
Associate Degree - Health Information Technology
University of Arkansas at Monticello
High School Graduate -
Hamburg High School