Barbara Kelley
Fort Oglethorpe
Summary
Detail-oriented professional with 8+ years in medical billing and insurance coding. Proven track record in resolving claims and training staff, enhancing operational efficiency. Strong commitment to optimizing reimbursement and ensuring compliance with payer regulations. Proficient in Epic and various medical software, with advanced skills in spreadsheets and Microsoft Office applications.
Overview
18
18
years of professional experience
Work History
Remote A/R Insurance Specialist
MedServ LLC
Chattanooga
06.2022 - Current
- Performed administrative functions for physician billing with a focus on accuracy.
- Handled accounts receivable, data entry, claims follow-up, and account adjudication tasks.
- Reviewed and analyzed denied claims to determine resolution strategies.
- Processed payer denials and submitted necessary appeals through Epic system and payer sites.
- Investigated client billing issues while identifying recurring charge denial patterns.
- Acquired expertise in commercial payers, managed care, Blue Cross Blue Shield, Medicaid, and CMS Medicare programs.
- Trained new hires as a mentor to support onboarding and skill development.
Remote Medical Billing Specialist III
CPSI/Trubridge
Mobile
01.2018 - 06.2022
- Perform basic administrative duties related to billing for a medical billing outsourcing company.
- Review, modify as necessary, and bill claims in the queue.
- Ensure all claims are submitted daily, with a goal of zero errors.
- Responsible for timely and accurate follow-up on claims with third-party commercial and government payers, with a specialty in Blue Cross Blue Shield.
- Reading and interpreting the EOB (Explanation of Benefits) and Remittance Advice.
- Denial management and A/R minimization.
- Communicate with the Billing Account Manager and the Assistant Manager via email and conference calls to discuss and resolve reimbursement issues and edits.
- Any additional duties or special projects, as requested by management.
AHS-CBO Account Representative
North American Credit Services Inc.
Chattanooga
03.2017 - 12.2017
- Executed administrative tasks associated with physician billing operations.
- Managed accounts receivable, including data entry and claims submission processes.
- Reviewed and appealed denied claims to maximize reimbursement.
- Researched and resolved client billing inquiries and discrepancies.
- Processed payer denials, ensuring timely follow-up and appeal submissions.
- Utilized knowledge of commercial payers, workers' compensation, and State Medicaid programs.
- Mentored new hires, overseeing training and development initiatives.
Patient Account/Revenue Cycle Specialist
Hutcheson Medical Center
Fort Oglethorpe
10.2007 - 01.2017
- Processed emergency room and outpatient lab claims using HMS clinic software and Quadex/Expeditor clearinghouse.
- Billed insurance claims electronically to multiple payers, ensuring timely submissions.
- Conducted audits on high dollar UB-04 claims prior to billing to promote quality improvement.
- Obtained pre-certifications and authorizations to verify benefits for covered services.
- Reviewed and appealed unpaid and denied claims to maximize revenue recovery.
- Managed facilities Account Query Reports, enhancing operational insights.
- Increased revenue turnaround through effective management of governmental insurance programs, including Medicaid and Medicare.
Education
High School Diploma -
Bearden High School
Knoxville, TN05-1984
Some College (No Degree) - Certified Medical Coder (CMC)
Georgia Northwestern Technical College
Rome, GASome College (No Degree) - Successfully completed humanities
Dalton College
Dalton, GASome College (No Degree) - Certified Billing And Coding Specialist Course
Academy Allied Health Careers
Chattanooga, TNSkills
- Claims management
- Denial resolution
- Insurance coding
- Financial reconciliation
- Payer relations
- Compliance adherence
- Data analysis
- Process improvement
- Client communication
- Training and mentoring
- Time management
- Problem solving
- Documentation
- Account management
- Documentation skills
- Reporting skills
- Revenue generation
- Health insurance
- Professionalism and ethics
- Customer service
Accomplishments
- I have received 4 "Lending a Hand" recognitions from my coworkers and managers within the MedServ LLC company.
Timeline
Remote A/R Insurance Specialist
MedServ LLC
06.2022 - Current
Remote Medical Billing Specialist III
CPSI/Trubridge
01.2018 - 06.2022
AHS-CBO Account Representative
North American Credit Services Inc.
03.2017 - 12.2017
Patient Account/Revenue Cycle Specialist
Hutcheson Medical Center
10.2007 - 01.2017
High School Diploma -
Bearden High School
Some College (No Degree) - Certified Medical Coder (CMC)
Georgia Northwestern Technical College
Some College (No Degree) - Successfully completed humanities
Dalton College
Some College (No Degree) - Certified Billing And Coding Specialist Course
Academy Allied Health Careers
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