Kimberly Prock

• Lead and manage a team of medical billers, coders, surgery schedulers and prior authorization specialists.
• Assign tasks and monitor performance.
• Train new staff and provide ongoing education.
• Conduct performance evaluations and provide feedback.

• Oversee the entire billing cycle from charge entry to payment posting.
• Monitor claim submissions, rejections, denials, and resubmissions.
• Ensure timely billing to insurance companies and patients.

• Analyze revenue trends and address discrepancies.
• Optimize reimbursement by reducing coding and billing errors.
• Work on improving cash flow and reducing AR

• Generate reports on billing, coding productivity, denials, and revenue.
• Present findings and improvement plans to leadership.
• Use data to inform operational decisions and training needs.

• Collaborate with providers to ensure proper documentation.
• Participate in budget planning and staffing forecasts.
• Address patient and payer inquiries or complaints related to billing.
• Negotiate payments/contracts with non-contracted insurance companies, third party payers and medical networks

• Assists the Care Management team in providing support, education, and assistance to members as they move within the health care system.
• Maintains, as assigned, an organized case management caseload of members to effectively and efficiently manage the members' individual care needs, to include member assessments and prior authorizations.
• Review high-end radiology prior authorizations and clinical documentation to support the approval or denial of authorizations.
• Review physical therapy, occupational therapy, and speech therapy clinical documentation for authorizations of additional therapy.
• Relate effectively with co-workers regarding the continuity of care.
• Maintain a professional approach with the highest standard of confidentiality.

Admissions Representative

• Clarification of customer requirements and development of approach to address them
• Administration of patient forms and responsible for providing concise instructions
• Registration and verification of patient insurance eligibility
• Verification and research of patient information in conjunction with insurance plan information and benefit eligibility

Medical Transcriptionist/ Secretary 11/2007 – 10/2009

• Transcribed pathology reports and autopsy reports for team of 5 Pathologists
• Responsible for Snomed coding of major cancer diagnoses
• Team training in transcription and cross training in phlebotomy
• Coordinated and maintained schedules for 5 Pathologists to ensure coverage

Laboratory Clerk 06/2005 – 11/2007

• Processed lab specimens from internal lab and other external facilities
• Provided instruction and addressed issues from various departments
• Coordination and follow-up with patient schedules
• Administration of drug screens
• Entered data from lab orders from other facilities into internal database