Summary
Overview
Work History
Education
Skills
Certification
Computer/EHR Experience
Timeline
Generic

Wendy Kirk

Fleming Island,FL

Summary

Seasoned Medical Management Specialist with 15+ years of experience in the healthcare industry. Expertise overseeing medical management operations, ensuring quality care, and optimizing patient outcomes. Skilled in utilization management, healthcare administration, and regulatory compliance. Proven track record in leading teams and implementing strategic initiatives to enhance organizational efficiency and patient satisfaction. Hands-on professional offering a keen understanding of data confidentiality and HIPAA regulations. Highly trained Medical Coder knowledgeable in AMA and the CMS coding rules.

Overview

18
18
years of professional experience
1
1
Certification

Work History

Practice Transformation Specialist/Coding Educator

Wellvana
Nashville, TN
02.2023 - 06.2024
  • Collaborate with Wellvana’s Director of Clinical Operations to utilize corporate resources effectively, driving achievement of Pey Performance Indicators (KPIs) at both the practice and market levels
  • Provide education and guidance on Value-Based Care clinical programs, ensuring healthcare providers are equipped to deliver high-quality, cost-effective patient care aligned with industry standards and regulatory requirements
  • Review coding, claims utilization, clinical, revenue cycle and quality data
  • Effectively communicate, build, and execute improvement plans at the practice level, based on areas of opportunity identified
  • Provide coding clinics to practices, to help improve their Risk Adjustment Factor (RAF) score
  • Develop and implement workflow design and redesign, including optimizing electronic health records (EHR), clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting
  • Facilitate patient follow-up after unplanned admissions and ED visits through coaching of providers and their staff
  • Collaborate with providers and their staff to improve continuity of care and streamline the intervention process
  • Actively participated in cross-functional teams to conduct work and resolve enterprise and regional issues
  • Performed other job duties as assigned.

Medical Office Manager

Providence Family Medical Clinic
Milwaukee, WI
12.2017 - 12.2023
  • Facilitated the daily operations of the medical office, including managing the staff, the office accounts, and other daily administrative operations
  • Kept abreast of insurance policies and guidelines
  • Manage office finances, including billing, budgeting, payroll, and purchasing supplies
  • Assured all insurance and patient payments were posted daily and reconciled all payments by the end of each workday
  • Train employees as needed and provide HIPAA training annually
  • Facilitated worker's compensation and Auto claims accounts and obtained the proper documentation from the patients to ensure claims payments
  • Followed up with attorneys or insurance companies to negotiate payment of claims and post all payments to the correct accounts
  • Review medical claims for submission to the clearinghouse, updated coding errors, and revised any coding inconsistencies
  • At the end of each week, claims were batched, reviewed, and scrubbed
  • Clean claims were then electronically filed to the insurance companies, attorneys' offices, or auto insurance companies
  • Conducted meticulous HEDIS reviews for coding accuracy and care gap detection
  • Each month Medicare and Medicaid claims were reviewed for HCC accuracy, assuring that each medical record was consistent with what was coded
  • Best coding practices resulted in higher financial gain for the practice
  • Streamlined the patient check-in process
  • Patient insurance was verified 24 hours before the appointment to ensure the insurance was active, what co-pays were due, and if there was a patient deductible
  • Maintained insurance portals, EMR, and clearing house; payments for all 835 files were always up to date.

Director of Reimbursement

Bell Ambulance. Inc. (3 Month Contract)
Pewaukee, WI
05.2017 - 08.2017
  • Led efficient staff meetings to boost productivity
  • Each meeting consisted of a financial analysis regarding accounts receivable and denials; a collaborative effort was made to reduce denials and increase accounts receivables
  • The meetings resulted in fewer denials and more revenue
  • Follow up on difficult claims promptly, to ensure prompt reimbursement
  • Review and evaluate cost reports for daily financial verification/comparison
  • Credential new insurance companies, maintain contracts and negotiate insurance contracts
  • Interview/hire and conduct performance reviews
  • Maintain Financial/insurance Portals.

HEDIS Analyst

AeroTech
Milwaukee, WI
01.2017 - 05.2017
  • Extracted patient data from EMR systems for verification, accuracy, and analysis
  • The data extracted is utilized in the medical record review process
  • The medical reviews for HEDIS scoring are reviewed for accuracy, medical documentation, and hierarchical coding
  • Reviewed patient diagnosis to ensure each diagnosis is aligned with what the provider has documented in the medical record
  • Concerns and questions would be queried to the provider for an update or confirmation of what was reported
  • Established positive and consultive relationships with Facilities, Physicians, and Nursing homes
  • Identify performance gaps, quality measures, and root causes
  • Communicated review findings and HEDIS score findings to Physicians and approved medical personnel.

Pension / Annuity Processor

Zenith American Solutions
Milwaukee, WI
04.2012 - 03.2016
  • Maintained customer data and processed pension applications and annuity payments calculating pension payments, insurance payments, and contractual adjustments
  • Organized and managed assignments by creating and updating data in Excel spreadsheets
  • Provided customer service to members; by addressing questions and concerns via letter, e-mail, and/or phone
  • Used accounts payable/ receivable for processing annuity payments, pension payments, processing insurance client payments, and refunds
  • Corresponded with vendors/clients and responded to inquiries regarding pensions
  • Documented all accounts payable transactions as needed
  • Prepared monthly and daily reports, all patient reports were added to the patient account.

Network Management Specialist

Anthem
Pewaukee, WI
06.2010 - 03.2012
  • Verified provider and facility documentation submitted for network approval
  • Review PECOS, CAQH, State licensing, and the background network for provider and facility profiles
  • Negotiate contracts if needed and ensure the validity of all information provided before providing an approval or denial
  • Approved providers and facilities were entered into the provider platform; and added to the networks of choice
  • Fee schedules were added to the accounts and the contracts were reviewed for errors and omissions before being finalized
  • Final contracts were mailed to providers/facilities
  • Denial letters were mailed as needed
  • Corresponded with physicians, nursing homes, and hospital directors in writing and by phone communicating important network information.

Billing Supervisor - Durable Medical Equipment (DME)

Carter’s Medical Billing
Milwaukee, WI
06.2006 - 05.2010
  • Manage durable medical equipment office, order medical supplies, oversee account receivables and account payables
  • Orders were processed once a week, inventory was updated, and payables were documented
  • Obtained authorizations for certain durable medical equipment products, billed/submitted claims to insurance companies, and posted account payments
  • Reconciled accounts ensuring all accounts were accurate and up-to-date information and then resolved identified errors
  • Assisted customers with billing, insurance coverage / EOBs, and ordering questions
  • Order Supplies and Ship Supplies.

Education

Masters of Science Accounting - Dual Concentration Degree, Accounting & Healthcare Management

Herzing University
Madison
12.2015

Bachelor of Science - Business Management - Business Management & Health Care Management

Herzing University
03.2012

Skills

  • Medical Management
  • Utilization Management
  • Healthcare Administration
  • Regulatory Compliance
  • Team Leadership
  • Strategic Initiatives
  • Patient Satisfaction
  • MS Excel
  • MS Access
  • MS Word
  • Epic
  • Zeus
  • Acclaim software
  • EClinical
  • AdvanceMD
  • Tebra
  • NextGen
  • Athena
  • Value-Based Care
  • Clinical Programs
  • Coding
  • Claims Utilization
  • Revenue Cycle
  • Quality Data
  • Workflow Design
  • Electronic Health Records (EHR)
  • Clinical Documentation
  • Billing Practices
  • Financial Analyses
  • Financial Performance Improvement
  • Patient Follow-up
  • Continuity of Care
  • Cross-functional Teams
  • Practice Transformation
  • Coding Education
  • Risk Adjustment Factor (RAF) Score
  • Market Levels
  • HEDIS Reviews
  • Coding Accuracy
  • Care Gap Detection
  • Insurance Policies
  • Office Management
  • Staff Management
  • Insurance Guidelines
  • Office Finances
  • Budgeting
  • Payroll
  • Purchasing Supplies
  • Insurance Payments
  • Worker's Compensation
  • Auto Claims
  • Medical Claims
  • Coding Errors
  • Coding Inconsistencies
  • Patient Check-in Process
  • Insurance Portals
  • EMR
  • Clearing House
  • Director of Reimbursement
  • Financial Analysis
  • Accounts Receivable
  • Denials
  • Cost Reports
  • Insurance Contracts
  • Performance Reviews
  • HEDIS Analyst
  • Patient Data Extraction
  • Medical Record Review
  • Hierarchical Coding
  • Facilities
  • Physicians
  • Nursing Homes
  • Performance Gaps
  • Quality Measures
  • Root Causes
  • Network Management
  • Provider Documentation
  • Facility Documentation
  • Provider Profiles
  • Fee Schedules
  • Denial Letters
  • Billing Supervisor
  • Durable Medical Equipment (DME)
  • Account Receivables
  • Account Payables
  • Medical Supplies
  • Insurance Coverage
  • EOBs
  • Order Processing
  • Inventory Management
  • Customer Service
  • Supply Ordering

Certification

CRC Certified, 06/2024

Computer/EHR Experience

Manage organization and production of business data and documents using MS Excel, Access, and Word. Processed medical billing (claim reviews, adjustments, payments, eligibility, and patient data) using Epic /Zeus / Acclaim software/ eClinical / AdvanceMD / Tebra / NextGen / Athena

Timeline

Practice Transformation Specialist/Coding Educator

Wellvana
02.2023 - 06.2024

Medical Office Manager

Providence Family Medical Clinic
12.2017 - 12.2023

Director of Reimbursement

Bell Ambulance. Inc. (3 Month Contract)
05.2017 - 08.2017

HEDIS Analyst

AeroTech
01.2017 - 05.2017

Pension / Annuity Processor

Zenith American Solutions
04.2012 - 03.2016

Network Management Specialist

Anthem
06.2010 - 03.2012

Billing Supervisor - Durable Medical Equipment (DME)

Carter’s Medical Billing
06.2006 - 05.2010

Masters of Science Accounting - Dual Concentration Degree, Accounting & Healthcare Management

Herzing University

Bachelor of Science - Business Management - Business Management & Health Care Management

Herzing University

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Wendy Kirk