Kiyana Long
Los Angeles,CA
Summary
Dynamic Support Specialist with over 10 years of experience in the medical billing and claims industry, skilled in managing data, addressing technical issues, and providing personnel support in diverse environments. Proven track record of delivering exceptional client assistance and resolving complex challenges through strong interpersonal skills and effective problem-solving strategies. Recognized for a customer-centric approach, reliability, and commitment to team collaboration, consistently adapting to evolving needs to achieve optimal results. Additionally, possesses a solid foundation in municipal law with extensive experience in legal advisory roles, contributing to policy improvements and successful legal proceedings through negotiation and research expertise.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Premium Support Specialist
Kareo, Inc
06.2019 - Current
- Assisting Billers and Coders with claim submission and coding errors
- Troubleshooting Kareo Medical billing software
- Providing General software support to providers and staff
- Building strong relationships with third-party electronic healthcare vendors and Clearinghouses
- Experience handling 835 EDl/837 EDI claims
- Understand and read ANSI files
- Provide specialized product support to billing companies, medical providers, and office staff while maintaining confidentiality of patient data and adhering to strict HIPPA regulations.
- Broke down and evaluated user problems, using test scripts, personal expertise and probing questions.
- Worked with software development team on reported errors and bugs on newly released software and assisted in deployment of release fixes.
Dispute Resolution Coordinator
Conifer Health Solution
01.2017 - 06.2019
- Gather resolution details for complaints, grievances, appeals
- Prepare and report documentation supporting verbal and written provider claims and pre-authorization appeals
- Adhere to strict guidelines and time frames set by The Centers of Medicare and Medicaid Services (CMS), Health Insurance Portability and Accountability Act (HIPAA), and the Health Plan
- Identify and match denied item(s) within case file, denial rationale presented b Medicare contractor and arguments of appellants
- Prepare resolution letters for member and provider appeals and grievances
- Interact and communicate easily with department personnel, medical providers, and members
- Maintain strong rapport with clients and overall client satisfaction
- Claims processing and evaluation for payment, fee schedule and eligibility.
- Processed and recorded new policies and claims.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Managed over 50 plus calls per day
Appeals & Grievance Coordinator
Mindlance
01.2015 - 01.2016
- Processed and resolved filed compliance according to the rules set by the company
- Prepared and reported documentation supporting verbal and written provider claims and pre- authorization appeals
- Prepared case files on policy holders and submitted for management review
- Adhered to the strict guidelines and time frames set by The Centers of Medicare and Medicaid
- Services (CMS), Health Insurance Portability and Accountability Act (HIPAA), and the Health
- Plan
- Identified and matched denied item(s) within the case file, the denial rationale presented by the Medicare contractor and arguments of appellants
- Prepared resolution letters for member and provider appeals and grievances
- Processing Claim issues with providers and Members in relation to appeal cases
- Interacted and communicated easily with department personnel, medical providers, and members
- Maintained a strong rapport with clients and overall client satisfaction.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Generated, posted and attached information to claim files.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Customer Service/Help Desk Advocate
OptumRx
01.2008 - 01.2015
- Maintained strong rapport with clients and overall client satisfaction
- Maintained accounts via CRM program
- Adhere to strict guidelines and time frames set by The Centers of Medicare and Medicaid
- Services (CMS), Health Insurance Portability and Accountability Act (HIPAA), and the Health
- Plan
- Trained new hires
- Resolving and processing claim issues for members
- Assisted with assurance and compiling matrix for team review
- Prepared monthly reports for supervisor review
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Processed 100 plus claims
Team Lead & Real, Trainer
Auto Club of Southern California
01.2001 - 01.2007
- Mentored and guided 15-20 employees ensuring all were trained in product knowledge and capableof performing assigned duties
- Maintained a strong rapport with clients and overall client satisfaction
- Processed and professionally respond to communication with members, road servicers, and operators
- Provided exemplar customer service to members in need of roadside assistance and/or drivingdirections
- Utilized various modes of communication to expedite service requests
- Managed schedules, accepted time off requests and found coverage for short shifts
Education
Some College (No Degree) - Clinical Nurse Specialist
Technical College
Communications
Los Angeles Southwest College
Los Angeles, CAHigh School Diploma -
Birmingham High School
Van Nuys, CA06.1998
Skills
- Hardware analysis
- HIPAA compliance expertise
- Skilled in utilizing customer relationship management systems
- Software Troubleshooting (4 years)
- End-user support expertise
- Data analysis proficiency
- Familiarity with Windows software applications
- Network troubleshooting experience
- Skilled in implementing API solutions
- Web Services
- Claim Validity Determination
- Efficient claims processing
- Policy explanation expertise
- Comprehensive legal evaluation
- Legal document drafting
- Persuasive communication
Additional Information
- Willing to relocate: Anywhere, Authorized to work in the US for any employer
Certification
Medical terminology
Timeline
Premium Support Specialist
Kareo, Inc
06.2019 - Current
Dispute Resolution Coordinator
Conifer Health Solution
01.2017 - 06.2019
Appeals & Grievance Coordinator
Mindlance
01.2015 - 01.2016
Customer Service/Help Desk Advocate
OptumRx
01.2008 - 01.2015
Team Lead & Real, Trainer
Auto Club of Southern California
01.2001 - 01.2007
Communications
Los Angeles Southwest College
High School Diploma -
Birmingham High School
Some College (No Degree) - Clinical Nurse Specialist
Technical College
Relocation
Willing to relocate: Anywhere
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