Kristal Blair
Lancaster,SC
Summary
Results driven Medical Biller with over 8 years of hands-on experience in account management, revenue generation and medical billing and coding. Accomplished in developing strategies to improve workflows and processes and actualizing procedures to enhance revenue generation. Demonstrated leadership skills guide teams towards success, optimize performance and sustain organizational success.
Overview
10
10
years of professional experience
Work History
Medical Billing and Collections Specialist
Therapeutic Solutions Behavioral Health
Chico, CA
08.2021 - Current
- Provided customer service support to patients who had questions about their bills or payments due.
- Processed credit card payments from patients in accordance with office policy.
- Ensured HIPAA compliance by maintaining confidentiality of all patient information.
- Reviewed patient records for accuracy and completeness of information in medical billing system.
- Resolved discrepancies between insurance companies and patients regarding payment of bills.
- Conducted research on insurance policies, procedures, and regulations to ensure compliance with all applicable laws.
- Entered procedure codes, diagnosis codes and patient information into [Software].
- Initiated collection efforts on unpaid accounts by contacting insurance companies or patients directly via phone or mail.
- Researched complex billing issues involving multiple providers or services rendered over a period of time.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
- Monitored aging accounts receivable balances ensuring timely resolution of outstanding balances.
- Worked closely with clinical staff to ensure accurate coding practices were followed.
- Developed strategies for improving collections performance while reducing bad debt write-offs.
- Prepared daily reports summarizing payments received from insurers or other sources.
- Updated patient accounts with information obtained from internal departments or external sources.
- Submitted refund requests for claims paid in error.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Validated primary source documents such as licenses, diplomas, certifications and other related credentials.
- Maintained detailed records of provider data in the credentialing database system.
- Performed initial review for new providers to determine eligibility for enrollment into the network.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Provided support in responding to inquiries from external parties regarding credentialing information.
- Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
- Researched discrepancies between submitted provider data and verified sources when necessary.
- Prepared correspondence for various departments concerning credentialing updates or requests for additional information.
- Participated actively in special projects or initiatives pertaining to improvement of operational efficiency within the department.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Checked applications for missing information and organized all paperwork.
Billing Specialist
Argyll Medical Group
Chico, CA
01.2014 - 08.2021
- Customer service ; anywhere from explanation of bill, insurance coverages, assistance with payments,
- Insurance eligibility to verify insurance information and obtain billing authorization.
- Processed and sent invoices, adjustments and credit memos to customers.
- Investigated and resolved issues to maintain billing accuracy.
- Collaborated with vendor and staff to gather data sources and expedite billing.
- Reviewed and sent accounts with overdue balances to third-party collections for settlement.
- Input payment history and other financial data to keep customer accounts up-to-date in system.
- Prepared manual billing data using related billing and service reports.
- Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.
- Resolved reimbursement discrepancies by analyzing information and notifying manager.
- Liaised with internal teams to clear error reports.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
- Established, enforced and optimized billing procedures to streamline operations and minimize aging balances.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Validated primary source documents such as licenses, diplomas, certifications and other related credentials.
- Maintained detailed records of provider data in the credentialing database system.
- Performed initial review for new providers to determine eligibility for enrollment into the network.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Assisted in developing and implementing departmental procedures related to provider enrollment and maintenance activities.
- Developed reports related to provider demographic information, status changes, verifications completed, as requested by management or external customers.
- Provided support in responding to inquiries from external parties regarding credentialing information.
- Interacted regularly with representatives from health plans and commercial payers regarding credentialing matters.
- Prepared correspondence for various departments concerning credentialing updates or requests for additional information.
- Served as a resource person for staff members seeking assistance in understanding complex regulatory requirements related to provider enrollment processes.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
Education
Certificate - Medical Assisting
Oroville Medical Assistant Program
Oroville, CA08.2013
Some College (No Degree) - General Studies
Butte College
Oroville, CA01-2012
Skills
- Clean claim submittal both Form 1500 & UB04
- Insurance verification
- Accounts Receivable Experience
- Billing Dispute Resolution
- Denials
- Appeals
- Payment posting
- Credentialing
- Contracting
- Collections
- Insurance Verification
- Bank Deposits
- Client Communication
- Collections Management
- Payment plans
- Research and due diligence
Accomplishments
Project Triwest VA-This is an A/R project Initiated by myself shortly after starting with Therapeutic-Solutions, PC.
This was a year long project that I worked closely with the Regional Director Bart Baylock on this project and accomplished the addition of CPT codes S9480/H0035 for both IOP/PHP services with TRIWEST VA providing the practice with a fee schedule for the codes, both codes were previously not available on the VA fee schedule. Successful completion in all Facility claims from 2020/2021 processing and paying in excess of $100k.
Timeline
Medical Billing and Collections Specialist
Therapeutic Solutions Behavioral Health
08.2021 - Current
Billing Specialist
Argyll Medical Group
01.2014 - 08.2021
Certificate - Medical Assisting
Oroville Medical Assistant Program
Some College (No Degree) - General Studies
Butte College
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