Kristin McDermott
Glyndon,MN
Summary
Experienced in managing patient interactions and scheduling procedures, demonstrating strong organizational skills and attention to detail. Proficient in processing claim adjustments and addressing inquiries from providers and members, ensuring compliance with established guidelines. Capable of handling sensitive information with discretion while maintaining a focus on outstanding customer service. Proven ability to work independently or collaboratively within a team environment, effectively resolving issues and enhancing operational efficiency.
Overview
28
28
years of professional experience
Work History
Patient Access Representative Endoscopy
Sandford Health
10.2024 - 01.2025
- Calling patients to schedule endoscopic procedures and manage caseloads timely.
- Taking inbound calls regarding patient procedures and questions.
- Working with nursing staff directly to navigate the specifics for each patient.
Claims Adjustor/Researcher
Blue Cross Blue Shield of North Dakota
05.2019 - 08.2024
- Responsible for processing claim adjustments timely and accurately based on desk level procedures and adjustment processes.
- Review provider and member inquiries from internal departments based on guidance in the inquiry and to adjust related claims.
- Responsible for researching provider and member inquiries for unsolicited refunds and determining if the refund can be accepted and the claims adjusted or if the refund needs to be reissued to the sender.
- Adjusting behavioral health claims but manually reviewing member history claims and applying the correct SAC.
- Processing and adjusting Medicaid Expansion claims.
- Working through numerous mass adjustments in a timely manner.
Claims/Customer Advocate NBPA
Blue Cross Blue Shield of North Dakota
11.2018 - 05.2019
- Assisting and educating members and providers via the dedicated phone line for the Dakotas Health Plan and NHS employees and retirees.
- Working claim’s adjustments in Eagle and learning to navigate the new claims system OSCAR to research issues and processes.
Customer Care Advocate
Blue Cross Blue Shield of North Dakota
04.2018 - 11.2018
- Assisted and educated members, providers and customers on products and plans offered by Blue Cross Blue Shield of North Dakota and affiliated companies.
- Researched, analyzed and resolved all inquiries.
- Processed and resolved members and providers issues of varying complexities involving claims.
- Processed ARF and incoming mail and fax requests.
Credentialing Specialist
Blue Cross Blue Shield of North Dakota
01.2017 - 04.2018
- Reviewed and processed prospective Blue Cross Blue Shield of North Dakota provider enrollment applications and participation agreements.
- Handled any applications related to provider communications, credentialing, research and application approval duties in a timely and detail oriented and professional matter.
Credentialing Specialist
Take Care Health
03.2012 - 11.2014
- Credentialed Nurse Practitioners and Physicians Assistants to work in Walgreens Walk-In Clinics throughout the United States, collected necessary documents, verified licenses, completed background checks and enrolled providers in Medicare/Medicaid and other insurances.
Patient Support/Medical Records
Take Care Health
03.2008 - 02.2012
- Provided patient support via the phone regarding Take Care Health clinics in Walgreens, answered questions, relayed messages to clinics and scheduled appointments.
- Also worked with the Release of Information handling medical records requests from insurance companies and other providers.
Billing Specialist
Sanford Healthcare Accessories
11.2006 - 02.2008
- Submitted claims for durable medical equipment to insurance companies, Medicare, and Medicaid for processing; also worked claim denials.
Third Party Liability/Subrogation
Noridian
03.2005 - 07.2006
- Submitted demands for payment to insurance companies and attorneys for accident/injury claims paid by Medicare.
Provider Support Representative
Noridian
11.2002 - 02.2005
- Verified patient Medicare status for providers and answered questions regarding Medicare claim denials.
Communications Assistant
Minnesota Relay Services
12.1996 - 07.2002
- Relayed phone calls for the deaf, hard of hearing and speech disabled.
- Also supervised the call center floor area and assisted in scheduling of employees.
Education
Special Education
Minnesota State University Moorhead
01.1992
Skills
- Proficient in Microsoft Office
- Ability to handle confidential or sensitive information
- Strong written and verbal communication skills
- Ability to work independently or with a team
- Excellent problem solving
- Time management
- Organizational skills
- Outstanding customer service
- Phone skills
- Proactive problem solver
- Thinking outside the box
- Proven team player
- Works well alone
- Little or no supervision
- Persuasive communicator
- Strong listening skills
- Desire to help others
Timeline
Patient Access Representative Endoscopy
Sandford Health
10.2024 - 01.2025
Claims Adjustor/Researcher
Blue Cross Blue Shield of North Dakota
05.2019 - 08.2024
Claims/Customer Advocate NBPA
Blue Cross Blue Shield of North Dakota
11.2018 - 05.2019
Customer Care Advocate
Blue Cross Blue Shield of North Dakota
04.2018 - 11.2018
Credentialing Specialist
Blue Cross Blue Shield of North Dakota
01.2017 - 04.2018
Credentialing Specialist
Take Care Health
03.2012 - 11.2014
Patient Support/Medical Records
Take Care Health
03.2008 - 02.2012
Billing Specialist
Sanford Healthcare Accessories
11.2006 - 02.2008
Third Party Liability/Subrogation
Noridian
03.2005 - 07.2006
Provider Support Representative
Noridian
11.2002 - 02.2005
Communications Assistant
Minnesota Relay Services
12.1996 - 07.2002
Special Education
Minnesota State University Moorhead
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