Samantha Kutyla
Summary
Meticulous Denial Specialist offering 12 years track of conducting prompt, thorough investigations of health insurance claims. Well-versed in establishing proof of loss by studying medical documents, assembling additional information from outside sources and initiating and conducting investigations of questionable claims. Responsible and mature individual possessing sound decision-making and interpersonal skills.
Overview
13
13
years of professional experience
Work History
Insurance Denial Specialist
Pegi Solutions
12.2022 - Current
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Resolved COB issues and refilled corrected claims.
- Communication with commercial and government carriers regarding denials via portals, written, or phone to reconsider, appeal or reprocessed.
- Reviewed medical records to ensure coding was accurate.
- Identified root cause of denials to provided carriers documentation required for reimbursement.
- Communicated with patients to assist with questions regarding patient responsibility. Assisted patients with COB issues and advised contact with member services for resolution.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Posting of contractual obligations.
Charge Entry Specialist, Insurance Denial Specialist
Access Medical Billing
01.2011 - 12.2022
- Captured and entered professional and facility charges.
- Entered patient demographics accurately to ensure first submission reimbursement.
- Verified insurance eligibility and information to update database.
- Answered questions and assisted providers and office staff to ensure proper billing process.
- Proficient knowledge of medical records, CPT codes, ICD 10 codes, proper use of modifiers, UBO4 and CMS 1500 billing.
- Worked with revenue cycle team to identify denial trends.
- Communicated with Insurance carriers regarding claim denials via portals and phones to reconsider/appeal.
- Obtained authorization and benefits verification for outpatient procedures and office visits.
- Professional and facility software experience with AdvancedMD, Epic, and G-Gastro.
Education
High School Diploma -
Morristown High School
Morristown, NJ06.1986
Skills
- Past Due Balance Management
- Filing Systems
- Adjustment Posting
- Insurance Claims and Denial Processes
- Patient Reimbursements
- Account Management Software
- Benefits Verifications
- Outstanding Clerical Abilities
- Work Organizing and Prioritizing
- Billing Software
- Excellent communication skills with patients, providers, and insurance carriers
Timeline
Insurance Denial Specialist
Pegi Solutions
12.2022 - Current
Charge Entry Specialist, Insurance Denial Specialist
Access Medical Billing
01.2011 - 12.2022
High School Diploma -
Morristown High School
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