KIMBERLY M. OZAINE
CYPRESS,TX
Summary
Team Lead/Management-Financial Clearance-Financial Counselor-Experienced Revenue Cycle Management.
Over15 years of experience within the medical revenue cycle arena: eligibility, verifications, collections, billing, payment posting, authorizations, claim editing, medical coding and training.
Dedicated professional eager to create and implement successful strategies to improve organizational efficiency.
Overview
18
18
years of professional experience
Work History
Senior Customer Service Representative
Houston Methodist
07.2024 - Current
- Served as a liaison between clinical departments, finance, and administration, ensuring smooth communication for proper revenue cycle management.
- Enhanced customer satisfaction by promptly addressing and resolving billing disputes.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Coordinated patient payment plans, balancing compassion with firmness to ensure timely payments while preserving positive patient relationships.
- Assisted patients in understanding complex billing statements, leading to increased trust between patients and healthcare providers.
- Managed a portfolio of high-risk accounts, effectively reducing bad debt write-offs through proactive communication and negotiation tactics.
Financial Clearance Specialist/Team Trainer
MD Anderson Cancer Center
01.2017 - Current
- Obtain and document verification of patient eligibility (and applicable effective dates) using the available institutional and/or payor systems, including real-time web portals and tools
- Document updated and/or corrected insurance information into the system in accordance with applicable department policies and procedures
- Manage work lists for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required preauthorization’s
- Seek to obtain pre-authorization through on-line web portals and tools, when available
- Accurately document all reference and pre-authorization numbers, along with payor contact information, into electronic health record
- Complete and timely submit all documents (PFA, COBRA, etc.,) requiring Supervisor approval for financial clearance
- Trained and mentored new hires on team processes and procedures and current staff on updates and changes that the payor or department may have implemented
Medical Insurance Collector
Tyvan
01.2016 - 01.2017
- Performed collection activities on complex denials and prepare appeals and other necessary actions on outstanding balances for BCBS, UHC, Aetna/Cigna and self-funded/commercial providers in the professional/facility fee environment
- Ensured accurate billing, timely submissions of electronic and/or paper claims, monitoring claims status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid Managed Care, and commercial insurance payers
- Processed appeals, and rebills of denied charges, rejected claims or any other issues that affect reimbursement
Patient Account Rep I
Healix Infusion Therapy
01.2015 - 01.2016
- Answered incoming from patients, insurance companies, and doctor offices in regard to billing issues, charges, and balance due
- Worked with various assistance program and patients to get the necessary documents faxed for copay approvals
- Used various system to research EMR, insurance benefits for upcoming procedures
- Worked closely with several doctors’ office making sure insurance info was updated so claims could be processed correct and in a timely manner
- Lastly, made in/outbound calls to patients regarding billing, setting up payment plans, update insurance
- Worked bad debt reports, profitably accounts
Patient Access Rep II/Insurance Verification Specialist
Cypress Fairbanks Medical Center
01.2007 - 01.2014
- Communicated in an effective and professional manner with Physicians, ancillary departments, nursing units, physicians’ office staff, insurance companies, as well as patients and their families (all Patient Access customers)
- Completed thorough and accurate documentation
- Obtains demographic, insurance and financial information from patient or guarantor
- Enters information in computer system with a high degree of accuracy
- Explained all required forms to the patient or guarantor and obtains the necessary signatures
- Ensured medical necessity compliance by obtaining necessary data, reviewing Compliance System, communicating information to patient or guarantor and obtaining necessary signatures
- Protected the financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility
- Verified insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes
- Posts payments in the computer system and generates the appropriate patient receipts
- Trained and mentored new hires on team processes and procedures and current staff on updates and changes that the payor or department may have implemented
Education
HS Diploma -
North Shore High School
05-1996
No Degree - Medical Assistant
Sanford Brown Instutite
Houston01-2000
Skills
- EPIC super user
- HIPAA Compliance
- Team Lead & Department Trainer
- Patient Access
- Intermediate MS Office skills
- Medical Revenue Cycle:
- Pre-authorizations-Eligibility & Insurance Verification Coding/Billing-Collections-Payment Posting-Denial management Medicaid & Medicare Commercial & Managed Care Plans
- Vendor Portals: Availity-Evicore-Passport/One Source-NIA/Magellan-AIM
- Staff training
- Call Center Operations
- Escalation management
- Teamwork and collaboration
- Patient account analysis
Timeline
Senior Customer Service Representative
Houston Methodist
07.2024 - Current
Financial Clearance Specialist/Team Trainer
MD Anderson Cancer Center
01.2017 - Current
Medical Insurance Collector
Tyvan
01.2016 - 01.2017
Patient Account Rep I
Healix Infusion Therapy
01.2015 - 01.2016
Patient Access Rep II/Insurance Verification Specialist
Cypress Fairbanks Medical Center
01.2007 - 01.2014
HS Diploma -
North Shore High School
No Degree - Medical Assistant
Sanford Brown Instutite
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