Kimberly Winslett
Austin,TX
Summary
Adept at claims processing and customer service, I significantly enhanced claim resolution efficiency at Financial Corporation of America. Leveraging expertise in HIPAA compliance and exceptional communication, I streamlined interdepartmental workflows and improved client satisfaction. My proactive approach and ability to adapt to changing priorities underscore my commitment to excellence and teamwork in fast-paced environments.
Overview
13
13
years of professional experience
Work History
Medical Insurance Representative
Financial Corporation of America
03.2016 - Current
- Developed strong working relationships with insurance carriers'' representatives to expedite approvals or denials when necessary.
- Demonstrated adaptability by staying flexible in adjusting priorities according to changes in workload or organizational needs.
- Expedited resolution of customer concerns, providing exceptional service through clear communication and active listening skills.
- Streamlined claim processing for faster reimbursement, utilizing knowledge of insurance policies and procedures.
- Paid or denied medical claims based upon established claims processing criteria.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Managed large volume of medical claims on daily basis.
- Identified and resolved discrepancies between patient information and claims data.
- Verified patient insurance coverage and benefits for medical claims.
- Researched and resolved complex medical claims issues to support timely processing.
- Collected premiums on or before effective date of coverage.
- Monitored and updated claims status in claims processing system.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Collaborated with healthcare providers to ensure accurate billing information was submitted, resulting in fewer denied or delayed payments.
- Analyzed customer needs to provide customized insurance solutions.
- Streamlined communication between departments by developing efficient methods for sharing claim status updates and relevant documentation.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
- Assisted in the development of training materials for new hires, improving overall team knowledge and productivity.
- Resolved discrepancies between billed amounts and allowed charges promptly by working closely with both providers and payers, minimizing delays in payment processing times.
- Reviewed provider coding information to report services and verify correctness.
- Generated leads through cold-calling, networking and other outreach methods.
- Responded to correspondence from insurance companies.
- Followed up on denied claims to verify timely patient payment and resolution.
- Stayed current on industry trends and changes in insurance policies, enabling accurate interpretation of coverage details for various plans.
- Enhanced team productivity by assisting in training new hires on company protocols and software systems.
- Coordinated across departments to ensure seamless communication regarding patient accounts, claim statuses, and dispute resolutions.
- Managed high call volume while maintaining accuracy and professionalism in documentation of interactions with customers.
- Assisted patients with understanding their benefits, coverage limitations, and financial responsibilities related to medical services received.
- Acted as a reliable resource for team members by sharing expertise on the medical insurance field, facilitating mutual growth and development within the department.
- Kept informed about updates within the field through regular participation in industry conferences and training sessions, applying new knowledge to improve performance.
- Collaborated with healthcare providers to resolve billing discrepancies, fostering positive relationships between parties involved.
- Self-motivated, with a strong sense of personal responsibility.
- Handled escalated claims-related issues professionally, working diligently towards resolution while maintaining strong relationships with both clients and providers alike.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Passionate about learning and committed to continual improvement.
- Worked flexible hours across night, weekend, and holiday shifts.
- Managed time efficiently in order to complete all tasks within deadlines.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Strengthened communication skills through regular interactions with others.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Developed and maintained courteous and effective working relationships.
Medical Debt Collector
Financial Corporation of America
11.2014 - 03.2016
- Processed online and paper appeal submissions and refund requests.
- Increased successful debt collections by implementing effective communication and negotiation strategies with patients.
- Developed rapport with patients through professional yet empathetic communication, resulting in higher willingness to cooperate during the collections process.
- Corrected, completed and processed claims for multiple payer codes.
- Maintained strict adherence to HIPAA guidelines while handling sensitive patient information during the collection process, ensuring confidentiality at all times.
- Managed a large caseload of diverse accounts, ensuring timely action was taken on each file according to established procedures and guidelines.
- Conducted thorough research on debtor assets to inform strategic approaches to recovery efforts and maximize potential returns for clients.
- Provided exceptional customer service during the debt collection process by addressing patient concerns, answering questions, and offering support in finding viable financial solutions.
- Reduced account delinquencies through diligent follow-up on past due accounts and negotiating feasible repayment options tailored to individual financial situations.
- Improved patient satisfaction by providing compassionate and empathetic assistance in resolving their medical debts.
- Listened to customers and negotiated solutions that met creditor and debtor needs.
- Processed debtor payments and updated accounts to reflect new balance.
- Contacted customers to discuss past-due accounts and negotiated payment plans.
- Entered client details and notes into system for interdepartmental access and review.
Secretarial Assistant
Safe Site Inc
12.2012 - 11.2014
- Welcomed office visitors and alerted staff to arrivals of scheduled appointments.
- Received and sorted incoming mail and packages to record, dispatch, or distribute to correct recipient.
- Developed office procedures to improve workflow efficiency, resulting in reduced operational expenses.
- Executed record filing system to improve document organization and management.
- Assisted in preparing timely and accurate reports for management decision-making purposes.
- Managed appointment scheduling for multiple staff members, ensuring smooth daily operations.
- Collaborated with team members on various projects, contributing to successful outcomes.
- Contributed to a positive work atmosphere through proactive communication and collaborative problem-solving efforts.
- Handled sensitive information with discretion, maintaining strict confidentiality at all times.
- Maintained a well-organized filing system for easy document retrieval, improving overall productivity.
- Generated reports and typed letters in Word and prepared PowerPoint presentations.
- Contributed to the development of an efficient office environment through continuous improvement initiatives.
- Provided exceptional customer service to clients and visitors, creating a welcoming environment.
Sales Associate
Bealls Dept Store
07.2011 - 09.2012
- Boosted customer satisfaction levels through exceptional service, addressing concerns promptly, and providing a welcoming store environment.
- Rotated stock and restocked shelves to maintain product availability and store appearance.
- Engaged in friendly conversation with customer to better uncover individual needs.
- Conducted product demonstrations to highlight features and redirect objections to positive aspects.
Education
High School Diploma -
Pflugerville High Shool
Pflugerville, TXSkills
- HIPAA Compliance
- Claims Processing
- Microsoft Office
- Policy Interpretation
- Medical Coding
- Healthcare billing
- Insurance regulations
- Customer Service
- Medical record review
- Insurance claims processing
- Quality assurance checks
- Thorough claims reviews
- Organizational abilities
- Medical terms and procedure knowledge
- Insurance Verification
- Medical Terminology
- Knowledgeable in Software
- Critical Decision-Making
- Proficiency in Software
- Telephone Etiquette
- Provider Relations
- Insurance Claims
- ICD Codes
- Electronic Claims Processing
- Insurance claims management
- Teamwork and Collaboration
- Time Management
- Attention to Detail
- Multitasking Abilities
- Reliability
- Call Center Customer Service
- Excellent Communication
- Customer follow-up
- Data Entry
- Professionalism
Timeline
Medical Insurance Representative
Financial Corporation of America
03.2016 - Current
Medical Debt Collector
Financial Corporation of America
11.2014 - 03.2016
Secretarial Assistant
Safe Site Inc
12.2012 - 11.2014
Sales Associate
Bealls Dept Store
07.2011 - 09.2012
High School Diploma -
Pflugerville High Shool