Kimothy Williams
Springfield,MA
Summary
Well seasoned revenue integrity professional knowledgeable about business systems and revenue cycle processes. Decisive and persuasive communicator with proven problem-solving, leadership and planning abilities.
Overview
33
33
years of professional experience
1
1
Certification
Work History
Revenue Integrity Specialist
Baystate Medical Practices
10.2002 - Current
- Identify, communicate, educate, and ensure resolution of high-level reimbursement issues providing guidance to Compliance Specialists, Billing Operations and Coding to positively impact prompt adjudication of claims
- Liaison with all governmental and commercial carriers for escalation and resolution of reimbursement and coding issues identified through billing operations; provide communication to senior management
- Represent BMP at internal and external meetings concerning denials, appeals, billing, and payment guidelines, including contract related meetings with payer representatives
- Work to foster provider/payor relationships to minimize denials and facilitate appeals
- Coordinate distribution of all payer updates to be reviewed and disseminated to coders, clinicians, billing, and practice staff
- Compile revenue reports to trend denials, determine root cause, and create system edits to reflect payer specific coding and billing guidelines
- Submit and validates that all contract rates, terms, and payment policies are loaded into payment variance software ensuring accurate reimbursement reporting and identification of any underpayments
- Served as system administrator for all users in payment variance software
- Compiled reimbursement analyses to be distributed to clinicians and senior leadership related to pricing, reimbursement, and payment policies to increase revenue opportunities
- Compiled various adhoc reports for specific provider types, billing areas and various other billing scenarios
- Prepared and maintained payer matrices to ensure proper billing and supervisory guidelines are followed
- Facilitated addition of any new CPT codes to Centricity Business ensuring proper system set up
- Audit contracts to ensure that reimbursement terms were interpreted and implemented correctly
- Assist with providing constructive feedback and developing training tools for accounts receivable staff
- Championed as Compliance, Audit and Education Specialist for Department of Pathology
- Liaison between pathology department and IT on interface failures and missing charge audits
- Resolved complex coding edits for pathology coder
- Responsible to resolve specific coding edits within ETM work file
- Perform quarterly Test to Claim Audits for department of Pathology
- Report any significant payer policy changes or updates to department of Pathology
- Designated subject matter expert for Sorian Financials for CDRC project.
Supervisor, Billing & Production
Baystate Medical Practices
01.2002 - 10.2002
- Daily coordination of the Production, Records Management, Customer Service , and Appeals departments
- Manage and monitor all paper and electronic claims submissions ensuring they are processed timely and accurately
- Daily coordination of the electronic remittance files
- Championed improvement strategies to reduce submission errors to will expedite payment
- Develop, implement, and maintain document imaging process
- Coordinate with Client Service Consultants regarding the resolution of issues between the patients and the practices
- Ensure that all patient correspondence and phone inquiries are handled timely and in a professional manner.
Team Leader, Appeals
Baystate Medical Practices
01.2000 - 01.2002
- Daily coordination of the appeals staff, ensuring that issues are identified and trended for resolution to maximize reimbursement
- Review reimbursement inquiries initiated by the staff to ensure accuracy of request
- Compile productivity reports of staff and report any issues to Senior Management
- Perform quality control of appeals completed for accuracy, professionalism, and timely filing.
Team Leader, Production/Records
Baystate Medical Practices
01.1994 - 01.2000
- Coordinate the day-to-day operations of the Production/Claims Processing and Records Management departments, ensuring team members were empowered to meet the goals as established for the department
- Utilizing the IDX System, Envoy/NEIC, and EDI, responsible for the accurate and timely output of all patient statements, electronic and paper claim runs, as well as accounts receivable reports
- Managed payroll, disciplinary, and annual review processes.
Claims Processor
Baystate Medical Practices
01.1993 - 01.1994
- Process over 25,000 third party paper claims timely and accurately per month
- Retain files for requests for attachments ensuring that all requests are filled timely
- Process electronic claims utilizing Envoy/NEIC and EDI applications.
Production Clerk
Baystate Medical Practices
01.1992 - 01.1993
- Generate and distribute third party claims and statements utilizing the IDX system
- Process and mail statements, credit letters and various form letters utilizing a burster and mail machine
- Process requests for claims and reports for various departments.
Education
College Preparatory/Business -
High School of Commerce
Springfield, MASkills
- Denial Management
- Data Analytics
- Claims Management
- Teamwork and Collaboration
- Attention to Detail
- Problem-solving abilities
- Microsoft Office
- Report Writing
Functionalsummary
Motivated, dedicated, and presents in a professional manner. Strong ability to multitask, organized, detail oriented and disciplined. Expert level experience with Cerner, Centricity Business, DBMS queries, Optum ClaimsManager edit building, and NHXS. Expertise in Microsoft Word, Excel, Outlook, and PowerPoint. Expert knowledge of CMS Medicare and Medicaid guidelines. Proficient in medical terminology, ICD-10, and CPT coding. AAPC Certified in Coding and Billing.
Certification
AAPC Certifications, CPC, CPB
Timeline
Revenue Integrity Specialist
Baystate Medical Practices
10.2002 - Current
Supervisor, Billing & Production
Baystate Medical Practices
01.2002 - 10.2002
Team Leader, Appeals
Baystate Medical Practices
01.2000 - 01.2002
Team Leader, Production/Records
Baystate Medical Practices
01.1994 - 01.2000
Claims Processor
Baystate Medical Practices
01.1993 - 01.1994
Production Clerk
Baystate Medical Practices
01.1992 - 01.1993
College Preparatory/Business -
High School of Commerce
AAPC Certifications, CPC, CPB
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