Summary
Overview
Work History
Skills
Certification
Accomplishments
Professional Affiliations & Leadership
Affiliations
Timeline
AccountManager
Kimberly Espinosa

Kimberly Espinosa

Business Healthcare Professional
Naples,FL

Summary

Results-driven healthcare professional with 40+ years of experience optimizing operations and improving billing and coding accuracy. Reduced operational costs by 15% and increased reimbursement rates through strategic risk adjustment. Expert in revenue cycle management, data analysis, regulatory compliance, and Value-Based Care. Proven success in leading teams to meet performance goals and enhance patient satisfaction by 20%.

Overview

29
29
years of professional experience
1
1
Certification

Work History

National Trainer of Provider Engagement

Optum
08.2021 - Current
  • Developed and handled comprehensive training programs on Risk Adjustment, Documentation and Coding, HEDIS metrics, STARS analytics, and technology integration, resulting in a 20% improvement in team proficiency scores
  • Collaborated with senior leadership to align training initiatives with strategic business goals, supporting a 15% increase in operational efficiency across the Practice Performance Team
  • Spearheaded the creation and implementation of a strategic training roadmap to enhance role-specific skills, contributing to a 10% boost in team performance metrics
  • Partnered with the National Project Manager to design and deploy data-driven reports, enabling actionable insights that increased field model efficiency by 25%
  • Played a pivotal role in executing the Practice Performance Team's strategic business plan, driving key initiatives that improved organizational outcomes and operational effectiveness

Medicare Consultant

Unitedhealthcare/Optum
03.2018 - 08.2021
  • Facilitated targeted Risk Adjustment training to providers through presentations to groups of 50+ and one-on-one coaching, increasing documentation accuracy by 20%
  • Leveraged data analytics to identify providers requiring improvement in MRA documentation and coding, resulting in a 15% reduction in coding errors
  • Educated providers on the Medical Condition Assessment Incentive Program and Medicare STARS, contributing to a 10% improvement in compliance and quality performance measures
  • Guided comprehensive chart reviews and provided tailored education based on findings, improving provider coding accuracy by 25% and ensuring alignment with regulatory standards
  • Enhanced provider understanding of risk adjustment methodologies and best practices, supporting an increase in STAR ratings and quality incentive achievements

MRA Consultant

Optum
06.2016 - 03.2018
  • Supported Healthcare Advocates in the HQ Path Program by streamlining processes across multiple payers, contributing to a 15% improvement in program efficiency
  • Implemented comprehensive training to providers and staff on Risk Adjustment and chronic condition coding using approved tools, leading to a 20% improvement in precision diagnosis capture
  • Moderated training sessions focused on documentation improvement and compliance, leading to a reduction in audit findings and a 10% boost in documentation quality
  • Monitored, tracked, and researched RAF scores to identify trends, implementing actionable strategies that strengthened overall risk adjustment accuracy by 12%
  • Performed clinical chart reviews and data mining to uncover undocumented diagnoses, capturing an additional 18% of eligible conditions and enhancing reimbursement outcomes

CODING COMPLIANCE MANAGER/CQI COORDINATOR

Healthcare Network
06.2011 - 06.2016
  • Operated detailed coding and auditing for Evaluation and Management (E/M) services and diagnoses across 24+ physicians, attaining a 95% accuracy in coding rate
  • Identified missed coding opportunities through data mining and educated providers on HCC capture, leading to a 20% increase in accurate risk adjustment documentation
  • Monitored and analyzed performance measures aligned with HEDIS and HRSA requirements, driving a 15% improvement in patient outcomes and compliance metrics
  • Oversaw the peer review process, ensuring quality and accuracy in medical documentation and coding practices
  • Led the organization's transition to ICD-10, implementing training and processes that ensured a seamless shift with no disruptions to coding operations

CODING/BILLING CONSULTANT/Owner

THE CODING CONFIDANT, INC
01.2003 - 01.2016
  • Conducted confidential medical coding and billing audits for multiple practices, identifying compliance risks and reducing billing discrepancies by 20%
  • Performed targeted internal audits of office staff, delivering detailed reports with actionable recommendations that maximized coding accuracy by 15%
  • Educated staff on effective coding and billing methods, resulting in an increase in compliance and proper reimbursement outcomes
  • Oversaw gap analyses of clinical documentation, uncovering opportunities for improvement that fortified compliant coding and increased reimbursements by 10%
  • Designed and executed a comprehensive Coding Compliance Plan based on OIG guidelines, updating billing and coding resources to align with current regulations and industry standards

MEDICAL CODING/BILLING INSTRUCTOR

LORENZO WALKER INSTITUTE
10.2003 - 12.2013
  • Delivered foundational instruction on medical billing and coding, equipping students with essential knowledge to excel in the field
  • Prepared students for national certification exams through the American Medical Billing Association and AAPC, achieving a 90% pass rate among program participants
  • Utilized the PMCC Curriculum to deliver structured, industry-standard training, enhancing students' comprehension and readiness for professional certification
  • Designed and administered interactive learning strategies, increasing student engagement and retention by 25%
  • Mentored students in coding and billing best practices, fostering career readiness and contributing to a 15% increase in post-certification employment rates

MEDICAL BILLING SUPERVISOR

FLORIDA DEPARTMENT OF HEALTH
12.2003 - 08.2011
  • Directed billing and coding operations for the health department, ensuring 98% accuracy, ICD-9/CPT compliance, and streamlined processes
  • Educated providers on coding updates and best practices, reducing claim denials by 15% and improving reimbursement efficiency
  • Led and coached a team of 2–15 full-time employees, achieving a 20% productivity improvement through staff development and weekly problem-solving meetings
  • Credentialed new providers and clarified software issues, minimizing onboarding delays and enhancing system functionality across departments
  • Chaired the DOH Special Interest Group on billing for Florida's 67 counties, leading statewide initiatives to improve billing processes and compliance metrics

CORF OPERATIONS ADMINISTRATOR

OUTREACH PROGRAMS, INC
10.2002 - 12.2003

OFFICE MANAGER/SCHEDULING COORDINATOR

NAPLES NURSING, INC.
05.2000 - 10.2002

INSURANCE/ACCOUNT REPRESENTATIVE-LEAD

COLLIER ANESTHESIA, INC
10.1995 - 05.2000

Skills

  • Project Management
  • Regulatory Compliance
  • Data Analysis and Reporting
  • Risk Adjustment and Coding
  • Team Leadership and Training
  • Provider Relations Management
  • Healthcare Operations Management
  • Billing and Reimbursement Strategies
  • Financial Management and Budgeting
  • Strategic Planning and Implementation
  • Customer Service and Patient Relations
  • Medical Auditing and Compliance Review

Certification

  • Project Management Essentials Certified, Management and Strategy Institute (MSI), 2022
  • Corporate Trainer Certified, Management and Strategy Institute (MSI), 2022
  • Six Sigma Green Belt in Healthcare, Lean Six Sigma, 2017
  • Certified Risk Coder (CRC), American Academy of Professional Coders (AAPC), 2017
  • Six Sigma White Belt, Lean Six Sigma, 2014
  • Certified Medical Practice Manager (CMPM), DoctorsManagement, 2013
  • Certified Professional Medical Auditor (CPMA), American Academy of Professional Coders (AAPC), 2009
  • Certified Professional Coder-Instructor (CPC-I), American Academy of Professional Coders (AAPC), 2005
  • Certified Medical Billing Specialist (CMRS), American Medical Billing Association (AMBA), 2004
  • Learn to Lead Graduate, University of Florida, 2003
  • Certified Professional Coder (CPC), American Academy of Professional Coders (AAPC), 2003
  • Certified Professional Coder (CPC), American Academy of Professional Coders (AAPC), 1993

Accomplishments

  • Spearheaded training initiatives for 100+ providers at Optum, enhancing Risk Adjustment, Documentation, and Coding proficiency, driving a 20% uplift in coding accuracy and compliance to align with Value-Based Care goals.
  • Coordinated a cross-functional team to design and deliver training modules supporting HEDIS proficiency, STARS data analytics, and technology integration, contributing to a 15% boost in operational performance efficiency.
  • Boosted RAF score tracking and documentation practices for healthcare providers, impacting reimbursement accuracy and reducing coding discrepancies by 18%.
  • Steered coding and auditing processes for 24+ physicians at Healthcare Network, achieving a 95% coding accuracy rate while overseeing ICD-10 transition and provider education to meet Value-Based Care standards.
  • Founded and grew the Naples Chapter of the American Academy of Professional Coders, leading it to become a key resource for 50+ local professionals and serving in multiple leadership roles within the AAPC.

Professional Affiliations & Leadership

  • Board Member, American Academy of Professional Coder Chapter Association, 2021
  • Chapter Secretary, American Academy of Professional Coders, 2020-2021
  • Chapter President, American Academy of Professional Coders, 2016-2017
  • Member, American Medical Billing Association, 2005
  • Founder, Naples Chapter of the American Academy of Professional Coders, 2016
  • Advisory Board Member, I-Tech Coding program, 2016
  • Active Member, Toastmasters International

Affiliations

  • Healthcare

Timeline

National Trainer of Provider Engagement

Optum
08.2021 - Current

Medicare Consultant

Unitedhealthcare/Optum
03.2018 - 08.2021

MRA Consultant

Optum
06.2016 - 03.2018

CODING COMPLIANCE MANAGER/CQI COORDINATOR

Healthcare Network
06.2011 - 06.2016

MEDICAL BILLING SUPERVISOR

FLORIDA DEPARTMENT OF HEALTH
12.2003 - 08.2011

MEDICAL CODING/BILLING INSTRUCTOR

LORENZO WALKER INSTITUTE
10.2003 - 12.2013

CODING/BILLING CONSULTANT/Owner

THE CODING CONFIDANT, INC
01.2003 - 01.2016

CORF OPERATIONS ADMINISTRATOR

OUTREACH PROGRAMS, INC
10.2002 - 12.2003

OFFICE MANAGER/SCHEDULING COORDINATOR

NAPLES NURSING, INC.
05.2000 - 10.2002

INSURANCE/ACCOUNT REPRESENTATIVE-LEAD

COLLIER ANESTHESIA, INC
10.1995 - 05.2000

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Kimberly EspinosaBusiness Healthcare Professional