Kimberly Paulinski
Summary
To maintain an Administrative Support Position. Dedicated administrative professional well-versed in communication and team building. Knowledgeable in medical terminology and scheduling. Ready to bring 15 plus years of relevant work experience to your team.
Overview
26
26
years of professional experience
Work History
Patient Access Specialist
UChicago Medicine
03.2021 - 02.2024
- Responsible for overseeing the scheduling of the new Plastics patient's initial appointment with the appropriate provider and will coordinate complex joint appointments and referrals for lab testing and imaging procedures prior to first visit in communication with program liaisons and providers
- Anticipates patients' frequently asked questions and concerns by assuming a proactive approach prior to the initial visit
- Directs patient and caregiver questions and concerns to appropriate UCM clinicians, administrative staff and providers
- Obtains patients' authorization and verifies that all medical records, pathology slides and specimens, faxes and other items necessary for the initial visit have arrived
- Collaborates with pre-visit team to obtain prior insurance authorizations and communicates with patient/caregiver as needed throughout process
- Putting the patient in touch with services; financial, social work, transportation, etc
- Provides information on appropriate clinical trials and information regarding disease diagnosis (via web or printed materials)
- Maintains statistics and generates reports for managers and others to identify new patient needs, trends, referral patterns, access barriers and to track outcomes related to the Support Coordinator role to ensure continuous improvements to service and access.
- Enhanced patient satisfaction by providing efficient registration and scheduling services.
- Streamlined front-desk operations for improved patient flow and reduced wait times.
- Verified insurance coverage and obtained necessary authorizations to ensure timely billing and reimbursement.
- Maintained patient confidentiality by adhering to HIPAA guidelines and hospital policies.
- Collaborated with clinical staff to ensure seamless coordination of care for patients.
- Reduced billing errors by verifying demographic information and updating records as needed.
- Supported the implementation of new processes or technologies for improved workflow efficiency in the department.
- Educated patients on available resources, programs, and financial assistance options to optimize their healthcare experience.
- Improved overall department performance metrics through consistent adherence to established protocols and procedures.
- Participated in ongoing training programs to stay current with industry trends and best practices in patient access services.
- Handled sensitive situations involving distressed patients with empathy maintaining professionalism throughout interactions.
- Collected and validated patient demographics and insurance information.
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
Utilization Management Specialist
DuPage Medical Group/Boncura
04.2018 - 02.2021
- Process referrals in accordance to Boncura Policy /Procedures and health plan requirements
- This includes checking eligibility, verifying benefits, verifying medical necessity, and knowledge of referral networks
- Contacts health plans for referrals/ pre-certifications that require health plan approval
- Applies MCG guidelines, Medical Group Guidelines and CMS coverage determinations to referral requests as appropriate
- Ensures referrals are approved within network as medically appropriate
- Reviews referrals not meeting medical group criteria with the Medical Directors as needed
- Initiates the processing of denials in accordance with health plan and regulatory requirements under the direction of the Manager, Care Management and Medical Director
- Interacts in a professional manner with providers, patients, physicians and staff by demonstrating respect not limited to communications via telephone, E-mail, My Chart or Staff Message
- Act as a resource for the Clinical Services Department, physicians, providers, patients and work colleagues
- Assist with submission of health plan reporting to ensure health plan compliance
- Ability to utilize resources and problem solving skills to achieve resolution when addressing questions/issues from patients, providers, and staff
- Maintain confidentiality in compliance with HIPPA
- EPIC EHR experience a
- Data Entry sills of 30+ wpm required.
Financial Clearance Specialist
Northwestern Medicine
01.2014 - 04.2018
- To initiate and coordinate pre-certification and prior authorization for patients with their insurance carrier
- Coordinate with the patient, physician, insurance company, and hospital on the complete certification process, including second opinions and tertiary referrals
- Receive and process insurance information and forms from patients and insurance companies
- Prior- authorizations for Radiology and ambulatory services
- Prior-authorization's for Surgery, outpatient and inpatient
- Answering phones
- Knowledge in CPT and ICD 10 codes
- Prior-authorization for Dermatology Botox and light box treatments.
Practice Operations Supervisor
Internal Medicine/Peds/Derm Northwestern Medicine
01.2009 - 01.2014
- Supervising, hiring, training, teaching, coaching and scheduling of the front staff
- Knowledge in CPT and ICD coding and health insurance patient billing
- Training staff with new policies and procedures, answering phones, Confirmation calls, taking messages, collecting co-pays
- Utilized familiarity with large provider groups utilization of Epic for claims, reimbursement and coverage and eligibility
- Maintained all workque functions for two different sites
- Responsilbities include: charge review, claim edit (all payors,) patient, hospital, professional fee and charge router review
- Worked directly with providers to successfully resolve billing and documentation issues; also wrote processes for the entire Cadence Physician Group to manage all workque functions for each site as well as CBO (central billing office)
- Chosen by site Operations Management to help write processes to maintain claim edit workques as well as registration errors
- Work with Eligibility and benefits, reimbursement guidelines, appeal processes and claims resolution for all insurance payors commercial and government payors
- Responsible for all patient billing coding and insurance inquires and/or complaints
- Preparing medical records.
- Enhanced team productivity by providing ongoing training, coaching, and mentoring to staff members.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Improved operational efficiency by streamlining processes and implementing time-saving strategies.
- Managed daily operations for optimal performance, ensuring smooth workflows and timely completion of tasks.
- Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
Patient Service Representative 2
Northwestern Medicine
01.2007 - 01.2009
- Handled patient phone calls, updated all demographic and insurance information
- Scheduling appointments, medical record documentation both charts and EMR
- Confirmation calls, faxing, collecting co-pays and patient balances
- Enhanced office efficiency by managing multi-line phone systems and promptly directing calls to appropriate personnel.
- Maintained a well-organized front desk, contributing to a welcoming environment for patients and visitors.
- Assisted with insurance verification tasks, ensuring accurate billing and timely reimbursement for services rendered.
- Collaborated with clinical staff to coordinate care plans, resulting in improved patient outcomes.
- Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers.
- Facilitated patient registration by accurately entering demographic and insurance information into electronic health record systems.
- Contributed to the resolution of billing disputes by working closely with insurance companies and patients to clarify charges and payment expectations.
- Improved patient satisfaction by providing exceptional customer service during check-in and check-out processes.
Patient Service Representative
Corwin Medical Care
01.2005 - 01.2007
- Checking in patients, collecting insurance information and demographics
- Collecting co-pays, scheduling testing, making lab and x-ray appointments
- Doing prior authorizations for certain medical testing
- Answering phones, and taking messages.
Worker's Comp Claims Adjuster
City of Chicago
01.1998 - 01.2005
- Answering phones, preparing documents for the city investigators
- Prepping medical bills for payment, entering bills for payment into the Blue Cross Blue Shield City of Chicago system
- Attending City Council Meetings
- Filling, faxing, coping.
Education
Moraine Valley Community College
01.2005
Skills
- Specialist Referrals
- Patient Registration
- Financial Obligation Determination
- Solution Implementation
- Insurance Verification
- Medical Terminology Expertise
- EMR
- Data Entry Proficiency
- Health Information Obtainment
- Medical Terminology
- Front Desk Operations
- Fee Collection
- Appointment Scheduling
- HIPAA Compliance
- Patient Scheduling
- Documentation Accuracy
- Insurance Billing
- Telephone Etiquette
- Problem Solving
- Time Management
References
Furnished on request.
Timeline
Patient Access Specialist
UChicago Medicine
03.2021 - 02.2024
Utilization Management Specialist
DuPage Medical Group/Boncura
04.2018 - 02.2021
Financial Clearance Specialist
Northwestern Medicine
01.2014 - 04.2018
Practice Operations Supervisor
Internal Medicine/Peds/Derm Northwestern Medicine
01.2009 - 01.2014
Patient Service Representative 2
Northwestern Medicine
01.2007 - 01.2009
Patient Service Representative
Corwin Medical Care
01.2005 - 01.2007
Worker's Comp Claims Adjuster
City of Chicago
01.1998 - 01.2005
Moraine Valley Community College