KIMBERLY HINES, BSN, RN
Mesquite,TX
Summary
Observant Medical Surgical Registered Nurse offering with strong organization skills, detail oriented, and experience with providing bedside care and monitoring patient condition. . Kind and compassionate professional who is hardworking and a team player to achieve company goals. Manages 5:1 ratios with knowledge of EPIC EMR charting, collaboration with interdisciplinary team members, and patient centered care.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Registered Nurse, Medical-Surgical Unit
Texas Health Resources Rockwall
10.2023 - Current
- Perform and accurately document physical, psychosocial, and emotional assessments in EPIC.
- Utilize critical thinking skills in planning and prioritizing nursing care
- Identify and implement appropriate nursing interventions based on the completed assessment
- Evaluate implement interventions and modify care according to the evaluation
- Advocate for resources and support that enhance patient safety and unit/hospital-based initiatives.
Managed Medicare Collections
Texas Health Resources Corporate
04.2020 - 10.2023
- Validate claim denials by performing detailed investigations utilizing payer portals, and contracts by making phone calls to payers
- Update coverage and initiate rebills to payers
- Appeal erroneous payer denials and collaborate with payers and internal stakeholders to reduce/prevent denials
- Post contractual adjustments, and non-covered billable charges to balance the account accurately
- Communicate payer denial trends and errors in real-time to expedite recoveries
- Initiated conversations with Managed Care and Legal to discuss denial volume and any future contractual change.
Billing Manager-Appeals/Denials-Revenue Cycle
Baylor Scott & White Health
05.2016 - 12.2019
- Responsible for all functions of the Appeals process for both Physicians Billing and Hospital Billing: Coding, Charge Entry, EDI/Claim Submission/Claims Rejects, A/R Follow up, Patient Statements, Patient Calls, & External Collections activities
- Coordinated activities between departments, and analyzed daily, weekly and monthly reports to assure proper staffing and workflow in all areas by utilizing Key Indicator Reports
- Worked closely with leaders in the areas of Operations, Finance, Human Resources, Information Systems, Managed Care and Compliance to achieve business objectives and implement organizational strategy
- Motivated and lead a high-performance billing & collections team; recruit and retained talent
- Managed staff performance by providing regular feedback, performance reviews, and one-on-one meetings
- Trained new team members on company policies and accounting systems to keep team operations productive and efficient
- Performed accurate and fully compliant monthly closing processes, accruals and journal entries
- Reported denial trends and recoveries to senior leadership and facility CFO's to identify denial trends.
Collector II-Appeals and Denials -Revenue Cycle
Baylor Scott & White Health
12.2009 - 05.2016
- Validate claim denials by performing detailed investigations utilizing payer portals, and contracts
- Collaborate with Appeal Writers, Business Office, and/or Health Information Management to validate, refute, or resolve payer discrepancies
- Communicated payer denial trends and errors in real time to expedite recoveries
- Initiated conversations with Managed Care and Legal to discuss denial volume and any future contractual changes
- Established workflow for the Denial Resource Center and assisted with the expansion and training of all staff resulting in positive recoveries
- Led complete review of operational costs and potentially wasteful practices, resulting in minimal cost increases as company headcount and increased recoveries.
Education
Bachelor's Science in Nursing -
Western Governors University
08.2023
Bachelor's of Arts in Science -
University of Texas at Arlington
01.2020
Skills
- Intravenous therapy
- Pre-and Post-Operative Care
- Compassionate Care
- Clinical judgment
- Vital signs monitoring
- Medication and IV administration
- Critical Thinking
- Direct Patient Care
- Documentation
- Blood Draw and Sample Collection
Certification
American Heart Association BLS Certification, 07/2025
Volunteer Experience
- Visiting Nurses Association
- Dallas Independent School District/Alumni Volunteer
- Court Appointed Special Advocate (CASA)
Affiliations
- Sigma Gamma Rho Inc., Alpha Omicron Alumni Chapter
Compact License
Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, Tennessee,
Timeline
Registered Nurse, Medical-Surgical Unit
Texas Health Resources Rockwall
10.2023 - Current
Managed Medicare Collections
Texas Health Resources Corporate
04.2020 - 10.2023
Billing Manager-Appeals/Denials-Revenue Cycle
Baylor Scott & White Health
05.2016 - 12.2019
Collector II-Appeals and Denials -Revenue Cycle
Baylor Scott & White Health
12.2009 - 05.2016
Bachelor's Science in Nursing -
Western Governors University
Bachelor's of Arts in Science -
University of Texas at Arlington
American Heart Association BLS Certification, 07/2025
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