Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Kimberly McGahan

Urmston, Manchester

Summary

Brings valuable experience in evaluating and processing claims with attention to detail and fairness. Known for strong team collaboration and adaptability in dynamic environments. Proficient in analytical thinking and communication skills.

Overview

18
18
years of professional experience

Work History

Health Claims Assessor

International Medical Group (IMG)
08.2022 - 12.2024
  • Assess health insurance claims for validity and medical necessity.
  • Review medical records, diagnostic tests, and treatment plans for compliance with insurance policies
  • Collaborate with the Chief Medical Officer to verify the appropriateness of treatments based on medical necessity guidelines
  • Investigate and flag potentially fraudulent claims
  • Communicate regularly with healthcare providers and policyholders to resolve issues and ensure accurate claims processing


Medical Billing, Insurance & Coding

HBCS Medical Billing Inc
08.2019 - 03.2023
  • Processed medical claims, coded diagnoses and procedures, and billed insurance carriers.
  • UB04 and CMS 1500 formats.
  • Perform insurance verifications, including coverage details such as co-pays and deductibles.
  • Assist in the resolution of claim denials, re-submitting claims with adjustments as necessary.


Medical Biller and Coder

Aveanna Heathcare
09.2011 - 08.2019
  • Navigate electronic medical records
  • Prepared detailed, itemized bills and invoices, ensuring all charges were appropriately documented
  • Answer questions and handle complaints
  • Correctly code and bill medical claims for various hospitals and nursing facilities.
  • Processed medical claims, reviewed medical records
  • Communicated with providers to resolve discrepancies in claims or patient insurance.


Insurance Verification Specialist

Hoag Memorial Hospital Presbyterian
10.2008 - 09.2011
  • Contact insurance companies to obtain policy details and verify the patient’s insurance coverage, including co-pays, deductibles, and out-of-pocket expenses.
  • Confirm the patient’s insurance eligibility, benefits, and coverage with insurance companies before services are rendered.
  • Maintain accurate records of verification information for billing purposes
  • Contact patients to inform them of their coverage status or any issues with their insurance.

Tax Specialist / Paralegal

Ibarra's Income Tax
10.2006 - 08.2020
  • Conduct in-depth consultations with clients to understand financial situations and gather necessary documentation, such as W-2s, 1099s, receipts, and bank statements
  • Ensure clients are eligible for maximum deductions, credits, and exemptions to reduce their overall tax liability
  • Stay updated on tax laws, including changes and new legislation, and provide clients with strategies to minimize future tax obligations
  • Process DACA applications, ITIN renewals, and immigration documents, including notary public services

Education

Associates -

ORANGE COAST COLLEGE
COSTA MESA, CALIFORNIA
05.2015

Certified Professional Biller (CPB) - CPC

AMERICAN CAREER COLLEGE
ANAHEIM, CALIFORNIA
09.2008

Skills

  • Claims Assessment & Evaluation
  • Insurance Knowledge & Loss Assessment
  • Fraud Detection & Investigation
  • Customer Service & Communication
  • Negotiation & Decision Making
  • Medical Coding & Billing (Epic Systems, UB04, CMS 1500)
  • Critical Thinking & Problem-Solving
  • Time Management & Multitasking
  • Documentation & Record Keeping
  • HIPAA Compliance
  • Medical Billing & Coding Regulations (Medi-Cal, Medicare)
  • Insurance Verification & Coverage Clarification

Languages

Spanish
Native or Bilingual

Timeline

Health Claims Assessor

International Medical Group (IMG)
08.2022 - 12.2024

Medical Billing, Insurance & Coding

HBCS Medical Billing Inc
08.2019 - 03.2023

Medical Biller and Coder

Aveanna Heathcare
09.2011 - 08.2019

Insurance Verification Specialist

Hoag Memorial Hospital Presbyterian
10.2008 - 09.2011

Tax Specialist / Paralegal

Ibarra's Income Tax
10.2006 - 08.2020

Certified Professional Biller (CPB) - CPC

AMERICAN CAREER COLLEGE

Associates -

ORANGE COAST COLLEGE

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Kimberly McGahan