Kimberly D. Moreno
San Antonio
Summary
Highly organized and dependable professional skilled in managing multiple priorities with a positive attitude. Proven track record of meeting company goals and willingly taking on additional responsibilities. Committed to delivering exceptional results and contributing to the overall success of the organization.
Overview
9
9
years of professional experience
Work History
Credentialing Specialist
Mpowerhealth
09.2021 - Current
- Knowledge of federal and state regulatory requirements and accreditation standards for Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- Maintain, track and update all credentialing documents, including checking all applications for accuracy and completeness and providing status to parties in timely manner
- Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during the credentialing process.
- Conducted primary source verifications such as background checks, NPIs, NPDB and board certifications
- Tracks credentials for all providers to ensure all they are update to date with facility requirements
- Maintains excellent working relationships with the facilities to ensure timely and accurate credentialing & maintain strict confidentiality regarding providers
- Ability to protected health information understands HIPAA Privacy & Security policies & procedures
- Performs other duties, special projects & work independently and with team members on daily tasks
Insurance Verification Specialist
Mpowerhealth/Acquisition Billing Services
10.2018 - 09.2021
- Verified patient insurance benefits with carrier for co insurance, deductibles, out of pocket, claims address providers for accurate eligibility benefits including behavioral health
- Utilize knowledge of varies insurance portals such as Availity, Waystar, Blue Cross Blue Shield, Tricare, Workers Compensation claims and health programs
- Communicate professionally with various doctor offices, medical professionals and attorney offices regarding patient demographics, insurance claims, and insurance benefits
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Research and resolve complex problems by using critical thinking skills and ability to maintain confidentiality of all facility and patient information as required by company policy and procedures
- Trained new staff on current insurance verification procedures
- Complied with HIPAA guidelines and regulations for confidential patient data
- Managed high-volume insurance verifications within a timely manner
- Reduced errors in billing by accurately maintaining patient records with updated insurance information.
Medical Records Specialist
Mpowerhealth/Acquisition Billing Services
07.2017 - 09.2021
- Update & upload physician progress notes, history, patient demographics into electronic medical records
- Receiving incoming mail from various insurance providers
- Ability to maintain confidentiality of all medical records and sensitive information to comply with HIPAA regulations
- Communicating with teammates, management and other departments to establish procedures
- Interdepartmental cross training for additional assignments
- Processed medical records requests from outside providers according to facility, state, and federal law
- Ensuring the security of patient and client protected health information
Shipping/Receiving Clerk
Integrity Ancillary Management
04.2017 - 07.2017
- Handle clinical laboratory specimens and prepared samples for the testing process
- Maintain daily detail logs of quantity/types of specimens samples during the incoming and outgoing process
- Provided regular updates to management of productivity
- Adhere to company safety and compliance policies
- Processed specimens with limited supervision
Program Eligibility Specialist
Maximus Inc.
12.2015 - 03.2017
- Communicated with people from various cultures and backgrounds on application process & eligibility requirements while providing excellent customer service
- Processed and certified documents for accuracy and compliance with government regulations
- Trained staff on current eligibility requirements and policies
- Reviewed applications for different aid programs and determined which qualification criteria for individuals
- Maintaining flexibility to perform other duties as may be assigned by management
- Proven ability to learn quickly and adapt to new situations and company growth
Education
High School Diploma -
Navarro Academy/Phoenix Program
San Antonio, TX05.2005
Skills
- Detail-Oriented Professional
- Customer Service
- Effective Time Management
- Analytical Problem Solving
- Credentialing Management
- Microsoft Office Proficiency
Timeline
Credentialing Specialist
Mpowerhealth
09.2021 - Current
Insurance Verification Specialist
Mpowerhealth/Acquisition Billing Services
10.2018 - 09.2021
Medical Records Specialist
Mpowerhealth/Acquisition Billing Services
07.2017 - 09.2021
Shipping/Receiving Clerk
Integrity Ancillary Management
04.2017 - 07.2017
Program Eligibility Specialist
Maximus Inc.
12.2015 - 03.2017
High School Diploma -
Navarro Academy/Phoenix Program
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