Kimberly Hughes
Medical Claims Specailist
Henrico,VA
Work Preference
Summary
Motivated and Professional Health Care Claims Biller, seeking opportunities to bring my skills to new challenges. Adept at developing profitable and quality-focused processes and applying creative approaches to solving complex problems. Experienced in handling numerous projects at once while ensuring accuracy and effectiveness at prioritizing tasks and meeting deadlines.
Overview
25
25
years of professional experience
Work History
Revenue Claims Adjuster II
Home Care Delivered
06.2021 - 11.2025
- Currently the primary DME collector for Maryland Medicaid and all the Managed Care Organizations
- Maintained a proficient knowledge base for policies for Maryland, both contracted and non-contracted Managed Care Organizations.
- Examined claims forms and other records to determine insurance coverage.
- Was selected to work on pre payment audit process for CareFirst Blue Cross Blue Shield Medicare and Medicaid plans
- Successfully worked with Managers and Coaches to help with new collections procedures to reduce the current AR.
- Have taken on numerous projects and maintained my regular workflow performance
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Researched claims and incident information to deliver solutions and resolve problems.
Claims Adjuster
BCA Financial
08.2019 - 05.2021
- Worked mainly on Medicaid claims for inpatient procedures and doctors’ services
- Assisted with account resolution by communicating account information, offering solutions, and establishing payment arrangements.
- Answered customer questions regarding deductibles.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Medical Biller/Coder
Commonwealth Cares of Virginia
01.2018 - 08.2019
- Worked with a Federally Qualified Healthcare (FQHC) center as their main coder and biller; worked strictly with Medicare and Commercial Insurances
- Gathered extensive knowledge about how a FQHC works and the difference between Fee For Service and Specialty Care operations regarding billing and coding
- Worked exclusively on electronic billing and medical records for one client
- Maintained and created reports for client regarding work flow and process
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
Third Party Claims Adjuster
Change Healthcare
03.2017 - 10.2017
- Maintained an extensive knowledge of third party billing for auto claims; working with local attorneys on collections and filing of medical claims for accidents
- Worked as liaison between client (VCU/MCV Health Systems) and vendor (Change Healthcare); saw to daily operations between said client and vendor; established internal contacts in all group areas of client
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Performed assigned duties for all clerical and collections needs for vendor and customer
- Experienced onsite direct patient contact; worked to ensure patient understood billing and insurance processes and helped to get forms properly filled out
Medical Biller/Coder
Universal Healthcare Services
04.2012 - 09.2012
- Maintained a proficient knowledge base for policies for multiple State and Federal Government Health Care plans to include: Medicare, Medicaid, Tri Care and both contracted and non-contracted Managed Care/Health Maintenance Organization (HMO).
- Billed and coded claims electronically for inpatient and outpatient Neonatal and Post-Operative Work.
- Performed post coding reviews for accuracy and appeals division.
- Supported incoming and outgoing phone inquiries for collections.
Private Practice Medical Biller
Pediatrix Medical Group
03.2004 - 02.2006
- Supported incoming and outgoing medical bill collection phone inquiries and assisted self-pay patients on payment choices for payment plans.
- Submitted appeals and follow up on decisions with patients.
- Performed daily quality checks for correct use of ICD-9 Codes for billing private, state and Federal claims.
- Delivered timely and accurate charge submissions.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Collected payments and applied to patient accounts.
Education
Certificate - Medical Billing and Coding
J. Sargeant Reynolds Community College
07.2014
A.A.S. - Medical Laboratory Technician
J. Sargeant Reynolds Community College
05.1996
Skills
- Insurance Coverage Analysis, Pre-Payment Audit Procedures, Accounts Receivable Recovery, Claims Dispute Resolution, Regulatory Compliance, Medical Billing Research, Stakeholder Communication
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Revenue Claims Adjuster II
Home Care Delivered
06.2021 - 11.2025
Claims Adjuster
BCA Financial
08.2019 - 05.2021
Medical Biller/Coder
Commonwealth Cares of Virginia
01.2018 - 08.2019
Third Party Claims Adjuster
Change Healthcare
03.2017 - 10.2017
Medical Biller/Coder
Universal Healthcare Services
04.2012 - 09.2012
Private Practice Medical Biller
Pediatrix Medical Group
03.2004 - 02.2006
A.A.S. - Medical Laboratory Technician
J. Sargeant Reynolds Community College
Certificate - Medical Billing and Coding
J. Sargeant Reynolds Community College