Kimberly Green
Summary
Dedicated administrative professional well-versed in communication and team building. Knowledgeable in medical terminology and scheduling. Ready to bring 30 years of relevant work experience to your team.
Overview
30
30
years of professional experience
1
1
Certification
Work History
PATIENT SERVICE REPRESENTATIVE
Duke University Health System, PRMO
03.2008 - Current
- Referral for uninsured/underinsured patient to the appropriate area
- Obtains required pre-certification and/or predeterminations requiring detailed evaluation of clinical documentation for medical service and document accurately on an patients account
- Medical Doctor Overrides in an timely manner
- Monitor systems continuously (work list, faxes, voicemails, emails) for issues related to patient account completion in an timely manner, interacting with internal and external customers
- Initiate contact as necessary with clinic department referring physician, hospital utilization department to obtain and verify patient information like diagnosis, procedure codes, length of stay for accurate patient encounter completion
- Ability to work within different areas in department when needed
- Comply with all regulatory policies and procedures.
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
- Handled complex insurance pre-authorization processes accurately, enabling timely delivery of necessary medical services.
- Applied administrative knowledge and courtesy to explain procedures and services to patients and insurance payers.
- Trained new staff on filing, phone etiquette and other office duties.
- Engaged with patients to provide critical information.
MEDICAL BILLING
P & M Management Services
07.2007 - 09.2007
- Performed medical billing for Medicare/Medicaid clients receiving home health and community services
- Analyzed and problem solved denied claims
- Offered insight as to how better improve systems
- Verified eligibility and documented provider data into client's database
- Participated in workshops and other training opportunities to remain current on billing procedures, regulations and industry updates.
CLINICAL SUPPORT SPECIALIST
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09.2000 - 01.2006
- Analyze insurance coverage and benefits to ensure timely reimbursement
- Obtain authorizations for service rendered and document findings in billing system, per policy and procedure
- Collect and update demographic, insurance and financial data and enter into database
- Used screening tools to determine authorizations for clients and check for eligibility
- Gathered and analyzed medical data and collaborated with case managers for clinical review
- Determined appropriate diagnosis codes after assessing clinical information
- Strong knowledge of medical terminology
- Supervised new employees on job duties.
CUSTOMER SERVICE REPRESENTATIVE
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09.1994 - 09.2000
- Utilized crisis intervention techniques when necessary for Mental Health
- Screening and directing calls to various Medical Staff (case managers)
- Performed data entry using specific medical database, various documentation with medical notes for each call
- Received calls for physicians and made appointments with Case Managers
- Prepared documents and letters to clients and providers, prepared denial letters for different patient medical accounts
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
- Answered 800 or more customer telephone calls promptly to avoid on-hold wait times.
Education
Bachelor of Science Degree - Healthcare Management
University of Mount Olive
01.2016
Certificate - Medical Coding -
Vance Granville Community College
01.2005
Certificate- Word Processing Specialist -
ECPI Computer Institute
01.1992
Associate Degree - Data Processing
Phillips Junior College
01.1990
Skills
- Microsoft Office (Word, Excel, PowerPoint, OneNote)
- Intakes and Assessments
- Customer Service
- Systems (IDX, XP, AS400, Carelink, EPIC, Meditech, Hyland)
- Insurance and Billing
- Knowledge of ICD 10 Codes
- Medical Terminology
- HEDIS
- Professional Consultations
- Financial Assistance
- Eligibility Determinations
- Explaining Benefits
- Medicare and Medicaid Eligibility
- Excel Functions
- Data Visualization and Presentations (in progress)
- Python Programming (in progress)
- SQL (in progress)
- Statistical Analysis
- Tableau (in progress)
- Data Compiling (in progress)
- Data Cleaning (in progress)
Certification
- Financial Assistance Module for Medicaid Assistance (Duke LMS)
- Insurance and Coverage - Medicaid (Duke LMS)
- Introduction to Data Analytics (IBM Data Analyst Professional Certificate through Coursera)
Timeline
PATIENT SERVICE REPRESENTATIVE
Duke University Health System, PRMO
03.2008 - Current
MEDICAL BILLING
P & M Management Services
07.2007 - 09.2007
CLINICAL SUPPORT SPECIALIST
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09.2000 - 01.2006
CUSTOMER SERVICE REPRESENTATIVE
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09.1994 - 09.2000
Bachelor of Science Degree - Healthcare Management
University of Mount Olive
Certificate - Medical Coding -
Vance Granville Community College
Certificate- Word Processing Specialist -
ECPI Computer Institute
Associate Degree - Data Processing
Phillips Junior College
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