KIMBERLY MAY
Iconma
Fayetteville,NC
1
Language
13
years of professional experience
Experienced Reimbursement Specialist with over 9 years in navigating payer requirements and overcoming coverage barriers to ensure timely patient care. Collaborates with healthcare providers, pharmacies, and insurance carriers to secure approvals and minimize treatment delays. Manages high-volume cases with precision, leveraging analytical skills to optimize reimbursement strategies and enhance process efficiency.
Work History
Care Coordinator
1 Year 3 Months- Clarified patient insurance benefits, ensuring understanding of coverage, copay, and PA requirements.
- Verified clinical and insurance documentation during referral intake, facilitating timely access to therapy.
- Investigated patient insurance benefits, clarifying coverage, copay, and PA requirements to ensure patient understanding.
- Handled high-volume technical reimbursement inquiries, ensuring accuracy and professionalism in responses.
- Met or exceeded KPIs for service levels, call volume, adherence, and quality standards.
Sitter
5 Months- Developed individualized care plans to address specific needs of children.
- Documented changes and coordinated communication among families, caregivers, and multidisciplinary teams to strengthen collaborative care.
- Supervised daily activities to maintain safety and promote well-being of children in care.
- Documented changes and coordinated communication among families, caregivers, and multidisciplinary teams to enhance collaborative care.
- Communicated with parents about child progress and concerns to foster transparency and support.
Reimbursement Specialist
8 Years 7 Months- Reviewed patient insurance plans to clarify coverage, prior authorization requirements, copay details, and out-of-pocket costs.
- Assisted providers in gathering documentation, submitting PA requests, and following up with payers, ensuring timely approvals.
- Coordinated appeal letters and supplemental documentation for coverage denials, expediting resolution timelines.
- Coordinated appeal letters and supplemental documentation for coverage denials, improving resolution timelines.
- Coordinated appeal letters and supplemental documentation for coverage denials to enhance resolution timelines.
- Maintained accurate records, followed HIPAA guidelines, and ensured all interactions met regulatory and program standards.
Customer Service Representative
9 Months- Resolved customer inquiries and complaints, achieving high satisfaction and ensuring timely follow-up.
- Utilized CRM systems to track interactions and manage outstanding issues, improving response time and customer experience.
- Trained new team members on policies and procedures, enhancing service delivery and compliance with best practices.
Education
Associate of Science - Health Sciences (Medical Office & Billing Specialist)
- Training includes medical administrative procedures, RCM, reimbursement methodologies, insurance claims management, EMR systems, billing processes, industry regulations, ethics, and professional communication.
- GPA: 3.6
Skills
Insurance navigation
Reimbursement management
Medical billing knowledge
Reimbursement operations management
Process documentation
Care plan management
EMR/EHR system management
Care planning
EMR/EHR management
Patient instruction
Accomplishments
Graduated with my associates Degree in Health Science with Billing and Coding, GPA 3.6
Languages
English — Full Professional Proficiency
Timeline
Sitter
Focused Interventions
06.2025 - 11.2025Read More
Care Coordinator
Iconma
05.2025 - 08.2026Read More
Reimbursement Specialist
Mercalis
09.2016 - 04.2025Read More
Customer Service Representative
BCBS
04.2013 - 01.2014Read More
Ultimate Medical Academy
Associate of Science from Health Sciences (Medical Office & Billing Specialist)
Read More