Nikki Wilkes
Toledo,OH
Summary
Highly skilled healthcare professional with strong expertise in medical billing and coding. Adept at accurately processing patient data and insurance claims while ensuring compliance with regulations. Strong focus on team collaboration and achieving results, adaptable to changing needs. Proficient in medical terminology, coding systems, and electronic health records, with reliable and efficient work ethic.
Medical Billing and Coding Specialist with 10 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes.
Overview
2026
2026
years of professional experience
Work History
Senior Insurance Follow up Specialist
University of Toledo Physicians
04.2025 - Current
- Processed insurance claims efficiently, ensuring adherence to company guidelines.
- Coordinated follow-up communications with insurance providers to resolve outstanding claims.
- Analyzed discrepancies in billing and payment processes to identify root causes.
- Utilized electronic medical records (EMR) systems to track claim status and updates.
- Maintained detailed documentation of follow-up activities and outcomes for audit purposes.
- Boosted revenue recovery by identifying and resolving errors in billing and coding practices.
- Supported team members in resolving complex issues, fostering a collaborative work environment focused on continuous improvement.
- Participated in regular staff meetings to discuss and strategize action plans for problematic accounts, resulting in improved collections performance.
BILLING AND CREDENTIALING SPECIALIST
APEX SKIN/ APEX DERMATOLOGY
02.2023 - 07.2024
- Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
- Maintain internal provider grid to endure all information is accurate and logins are available.
- Maintain accurate and up to date provider profiles on CAQH, PECOS, NPPES AND CMS DATABASE
- Completer revalidation request issued by government payers
- Complete credentialing , re-credentialing, credentialing, and privileging, application to add providers to commercial payers, Medicare and Medicaid..
- Work closely with director of revenue cycle and billing staff to identify and resolve denials, rejections or authorizations issues.
- Assist patients with billing inquires, payments, and account discrepancies.
- Process all incoming and outgoing billing mailing follow up as needed.
- Post payments, adjustments, and zero pays EOB’s in an accurate and timely manner.
- Post patients payments in an accurate and timely manner to the appropriate line item charge
- Research and resolve “unapplied and/or unidentified” payments to ensure monies are properly distributed.
- Enter and balance payments payments as assigned by category (check, credit card, and/or electronic payments) by batch to internal deposit records for the day.
- Process end of the day reports (Internal deposit slips and clearing of financial queue).
- Employee safety: safety performs all duties; follow required protective protocols to ensure personal safety as well the safety of others
HB/PB Cash Posting Representative
TOLEDO HOSPITAL/PROMEDICAL PHYSICIANS
10.2018 - 02.2023
- Accurate and timely credentialing intake for all supported providers with hospital privileges, payor/plan credentialing certifications and regulations
- Acts as a liaison between providers/office staff and hospital or payor plans
- Accurately maintains provider information in credentialing software
- Timely responses to Onboarding providers/plans/hospitals for intake of new providers
- Accurately and timely input of billing information into the practice management system for payment
- Accurately review and update demographic and insurance information
- Perform a variety of registration, billing, follow up and collection functions for all payers
- Verify insurance benefits, limits, and patient obligations
- Process electronic remittance advice as well as manual posting files upon receipt from the back
- Review and resolve clearinghouse edits and identifies opportunity to build up front edits in the practice management system
- Works with clearinghouse on payor registration and issuers
- Work with internal department to obtain information for external requests including refunds, bad debt and contractual allowances for accuracy and processes as applicable
- Know and follow all billing regulations and corporate compliance plans
- Maintain current payor knowledge for effective claims management and follow up of unresolved claims
- Routinely reviews workflow for process improvement and efficiencies and provides feedback to management for implementation of charge
- Epic user
- I have worked with Availity, Athena.
HB/PB Cash Posting Representative and AR/Collections Agent
Kettering Health Network
07.2016 - 10.2018
- Responsible for all aspects of patient accounts, billing and collection processing
- Follow all compliance with departmental policies and procedures
- Knowledgeable experience in Physician and Hospital Billing
- Maintain accurate and competent cognition of balancing with all accounting functions
- Able to read and interpret computer reports and accurately and sufficiently perform math calculations
- Patient Accounts Representative
- Responsible for patient billing reconciliation and research of missing payments
- Follow up with collections process in compliance with company policy
- Exercise knowledge of payer regulations in compliance of Federal and Company policies
- Skilled in the use of Epic and Epremis systems
- Perform financial analysis on customer files
- Confidently works under the Patient Accounts Manager to complete all additional work as needed.
Licensed Nursing Assistant/ Health Unit Coordinator
Miami Valley Hospital/Premier Health Partners
09.2006 - 07.2012
- Ordered/distributed office supplies
- Answered phones and performed clerical duties, such as word processing, data entry and managed incoming and outgoing patients
- Assisted in the maintenance of medical charts and electronic medical records
- Provide direct care for patients while being admitted and discharged
- Assisted nurses with wound care for pressure ulcers, burn wounds, bed sores, and surgical site wounds
- Collected Patient specimens and data, including vital signs, input/output and others as delegated
- Assist patients in bathing registration, discharging, transporting, and pre/post operation care.
Dietary/Nursing Assistant
Toledo Hospital
01.1999 - 01.2005
- Requires attention to detail, ability to follow written and verbal directions and the ability to work with minimal
- Some knowledge of weights and measurements
- Requires the ability to make change and keep records accurately
- Ability to move about the hospital and between workstations
- Ability to communicate and respond to inquiries, requires effective interpersonal skills
- Ability to tolerate exposure to temperature changes, humid/hot conditions and unpleasant odors
- Occasionally move heavy carts and frequently lift light to medium weight equipment and supplies
- Ability to maintain a productive work pace.
- Position will provide basic patient care as assigned under the direct supervision of the professional nurse
- The Unit Clerk/Nurse Assistant functions as a member of a team, attending the nursing station, patient rooms, and performs clerical and reception functions
- They are also assisting with the hourly rounding completed on each unit
- Excellent customer service skills and the ability to work in a fast paced environment are a must
- Position also involves cross training as a unit Secretary
- This is a great opportunity for a current nursing student to gain experience in the nursing field.
Medical Biller Externship
Bee Well Kidz/AJ Medical Management
02.2016 - 04.2016
- Proficient in physician coding, inpatient hospital coding, outpatient coding, and facility coding
- Responded to inquiries from providers on a broad scope of coverage issues pertaining to eligibility, coordination/explanation of benefits, and payment schedules
- Carefully reviewed individual/group claims exercising a strong working knowledge of major medical plans and leading healthcare networks.
Education
No Degree - CPC License
AAPC
Online 04-2026
Medical Billing and Coding Graduate - undefined
American College for Medical Careers
Certificate of Phlebotomy - undefined
Mercy College of Northwest Ohio
General Studies, Diploma - undefined
Scott High School
Skills
- ICD-10 & CPT Coding
- Medical Billing & Reimbursement
- Claims Appeals
- Patient Needs Management
- Surgery Assistant
- Strong Research Skills
- EPIC Records System
- Administrative Support
- Insurance procedures
- ModMed
- Ecw
- Claims follow-up
- Payment posting
- Medical coding
- Team collaboration
- Medical terminology
- Patient scheduling
- Faxing orders
- Medical terminology proficiency
- Patient billing support
- Problem-solving
- Scheduling tests and procedures
- Clerical support
- Time management
- Epic systems
- Insurance verification
- Payment scheduling and collection
- Documentation review
- CPT coding
- Patient eligibility requirements
- Insurance authorizations
- Medical records verification
Timeline
Senior Insurance Follow up Specialist
University of Toledo Physicians
04.2025 - Current
BILLING AND CREDENTIALING SPECIALIST
APEX SKIN/ APEX DERMATOLOGY
02.2023 - 07.2024
HB/PB Cash Posting Representative
TOLEDO HOSPITAL/PROMEDICAL PHYSICIANS
10.2018 - 02.2023
HB/PB Cash Posting Representative and AR/Collections Agent
Kettering Health Network
07.2016 - 10.2018
Medical Biller Externship
Bee Well Kidz/AJ Medical Management
02.2016 - 04.2016
Licensed Nursing Assistant/ Health Unit Coordinator
Miami Valley Hospital/Premier Health Partners
09.2006 - 07.2012
Dietary/Nursing Assistant
Toledo Hospital
01.1999 - 01.2005
Medical Billing and Coding Graduate - undefined
American College for Medical Careers
Certificate of Phlebotomy - undefined
Mercy College of Northwest Ohio
General Studies, Diploma - undefined
Scott High School
No Degree - CPC License
AAPC