Kimberly Pointer
Frisco,TX
Summary
Accomplished accounts and claims analyst with a successful track record in the healthcare industry, specializing in accounts receivable and collections. Conducts thorough account research and analysis to foster strong client relationships. Proven ability to manage multiple projects simultaneously in a fast-paced environment, ensuring timely debt resolution. Adept at effective communication and collaboration across functions to achieve objectives, minimize risk, and enhance customer satisfaction. Known for exceptional organization and attention to detail. Core competencies include accounts receivable, organization, attention to detail, client relationship management, research, and effective communication.
Overview
27
27
years of professional experience
2
2
Certification
Work History
Senior Medicaid Billing Specialist
Behavioral Innovations
02.2023 - Current
- Ensures proper submission and adjudication of all claims submitted to Medicaid carriers while working within the deadlines and protocols of the assignments.
- Focus primarily on reviewing and accessing Medicaid denials or returned claims.
- Focused on acquired knowledge, insurance carrier guidelines, company policies & procedures and research.
- Initiated resubmission of claims to Medicaid and MCO's.
- Resolve issues that created a denial within 1 day of receipt of denial.
- Identify and investigate Medicaid claim issues to resolutions.
- Significant Healthcare credentialing experience.
- Updated claims once Provider license is re-activated.
Meditech AR Cleanup Analyst (Consultant)
Frasier Healthcare Consulting, Inc
02.2022 - 12.2022
- Managed 4 hospital Facilities for Medicaid Government payers.
- Completed follow-up on daily basis on accounts pending requested information, reviewed and initiated Appeals and reconsiderations in a timely manner to resolve overpayments, underpayments and credit balances.
- Monitored and managed the accounts receivable collection process, determine if underpayments is related to non covered charges.
- Held meetings with Provider Relations Representatives concerning trending claims issues.
- Coding for Modifier, APR- DRG downgrade, Clinical Appeals or Authorization.
- Evaluated Accounts Receivable and collected $1,900,000.00 in pass due accounts Follows hospital specific processes when returning an account for hospital action.
- Identified opportunities for optimization through data mining techniques such as trend analysis or pattern recognition.
Reimbursement Case Manager
CareMetx
10.2020 - 06.2022
- Worked interactively with patients, healthcare providers, pharmacies, and manufacturer clients.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Provided reimbursement information to providers and/or patients.
Senior Claims Analyst
United International Surgical Partners
06.2018 - 01.2020
- Reviewed and initiated Appeals, Medical Records requests and reconsiderations in a timely manner to resolve overpayments, underpayments, and credit balances.
- Conducted rigorous audits to ensure compliance with industry regulations, internal policies, and best practices.
- Negotiated successful outcomes for clients by leveraging strong analytical skills and knowledge of insurance policies.
- Reviewed contracts for revenue capture and maximize for billing and coding guidelines.
- Served as a subject matter expert on complex claim cases, offering consultation and guidance to colleagues in need of assistance.
- Updated accounts with any new or corrected information received on an account.
Medicare Team Lead
Christus Health
07.2012 - 06.2018
- Managed hospital claims for Government payer.
- Analyzed variances, completed follow-up on daily basis on accounts pending requested information, identifying payer trends, handled all correspondence related to patient accounts, correct system edits via Novitas System/CMS.
- Assisted team with Medicare processes, assigned team work daily, monitor productivity, reviewed and release team adjustments daily over assigned threshold.
- Oversee Team consist of 30 employees and audit Team claims. Prepared assigned Monthly team schedule for Shift Briefings and Correspondences.
- Approved high dollar refunds, bad debt placements and AP invoices for payments, Responsible for accurate allocation of payments to patient accounts Audit cash postings and rollovers accounts to identify training opportunities.
- Coached team members in techniques necessary to complete job tasks. Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
- Influenced positive change within the organization engagement committee through strategic thinking, innovation, problem-solving abilities, and consistent leadership style.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
Education
No Degree - Health Services Administration
Strayer University
Plano, TX01.2027
Skills
- HIPAA Compliance Understanding
- Critical thinking abilities
- Coaching and Mentoring
- Problem-Solving
- Attention to Detail
- Critical Thinking
- Customer service and support
- Team Leadership
- Active Listening
- Effective Communication
Certification
- Prior Authorization Certified Specialist
- Texas State All Lines Adjuster License
- Lean Six Sigma Training
Timeline
Senior Medicaid Billing Specialist
Behavioral Innovations
02.2023 - Current
Meditech AR Cleanup Analyst (Consultant)
Frasier Healthcare Consulting, Inc
02.2022 - 12.2022
Reimbursement Case Manager
CareMetx
10.2020 - 06.2022
Senior Claims Analyst
United International Surgical Partners
06.2018 - 01.2020
Medicare Team Lead
Christus Health
07.2012 - 06.2018
No Degree - Health Services Administration
Strayer University
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