KIMBERLY Bryan
Stockbridge
Summary
Motivated and dedicated professional with 20+ years of expertise in staff development and conflict resolution. Proven track record of success in client relation, management, administrative operations. Demonstrates expert insight and proficiency in enforcing policies and procedures. Skilled and collaborative team leader with experience in coordinating, planning and supporting daily operations.
Overview
22
22
years of professional experience
Work History
Quality Improvement Specialist
Centene/Peachstate
Atlanta, GA
03.2021 - Current
- Reduced customer complaints significantly by conducting thorough root cause analysis and implementing corrective actions.
- Enhanced production efficiency by developing and executing process control plans, leading to reduced waste and rework.
- Collaborate with team members on projects obtaining proper authorizations, adhering to HIPAA requirements, and policies when obtaining medical records.
- Liaised with healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
BUSINESS OFFICE INSURANCE COORDINATOR
NORTHSIDE HOSPITAL
02.2019 - 10.2023
- Responsible for verification of insurance for patients being admitted into the hospital
- Complete all needed paperwork, obtaining demographics to ensure correct billing
- Participate in meetings for professional development and updates on company process
- Demonstrate thorough knowledge of insurance policies and plans, educating clients on benefits
- Review documentation for accuracy and integrity, maintaining client confidentiality in compliance with HIPAA privacy guidelines.
- Quality Assessments reviews on 15 employees, monitoring, assessing, and reviewing quality of work on accounts.
REFERRAL COORDINATOR
KAISER PERMANENTE REGIONAL OFFICE
07.2018 - 01.2019
- Interpret, maintain and utilize knowledge of HP benefits, contractual arrangements, NWP protocols and RRC departmental policies and procedures
- Receive and review admission and discharge notifications
- Analyze referral requests, ensuring they meet established departmental protocols
- Coordinate patient care with non-Plan providers, approve and validate authorization information for payment by Claims Administration
- Interpret referrals limitations, and communicate information as needed to members
- Provide all needed information for scheduling of appointments and request the transfer of medical information
- Quality check all information related to authorizations and denials for accuracy.
INSURANCE VERIFICATION & PATIENT ACCOUNT COORDINATOR
ORTHO-ATLANTA
04.2017 - 07.2018
- Contact the patient’s insurance company to verify coverage levels and works with individuals to educate them on their benefits information
- Ensure that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system prior to patients appointments.
- Initiate the pre-authorizations/pre-determinations for insurance to get verified and processed correctly for MRI and Clinical Appointments
- Communicate with patients about delinquent balances by answering and resolving concerns and assist with repayment terms
- Train employees and staff on insurance benefits requirements for MRI and Clinical Office Visits.
REFERRAL COORDINATOR
THE MEDICAL GROUP
10.2015 - 04.2017
- Coordinated with the HIM staff to track the status of all provider reports on patients referred to hospitals, outside clinics and Specialty
- Providers and followed up for reports/records not received on referred patients
- Maintained an accurate records of referral patient’s appointments that are kept, failed, and current status in the Referral Tracking System or EMR; Monitor Referral Tracking System for outstanding, provider reports and follow-up with the appropriate provider
- Produced an accurate bi-weekly report of all clients designated as needing, (Intensive Tracking), which documented efforts, results, and status of each patient
- Scheduled, problem solved, communicated, and coordinated referral appointments with outside specialists.
BUSINESS OPERATIONS SUPERVISOR
FIRST GA PHYSICIANS GROUP
01.2014 - 10.2015
- Served as a role model to other staff members through the demonstration of leadership skills and by sharing knowledge; served as a preceptor for new non-clinical staff
- Ensured that patients with problem and/or past due accounts are notified in advance of their appointments to discuss financial and/or insurance issues
- Instructed front office staff of the action to be taken on problem and/or past due accounts and the amount to collect at the time of service and charges posted to accounts
- Acted to resolve and mediate for resolution of perceived problems or corrective measures within established facility policies that met both patient/family requests and the clinicians feel are safe for care
- Maintained the supervisor's appointment calendar, schedules appointments independently, reminded the supervisor of meetings, briefed the supervisor on the subject matter prior to the meeting, and made the administrative arrangements as required.
FRONT OFFICE COORDINATOR
BIBB MEDICAL CARE
07.2009 - 01.2014
- Responsible for obtaining accurate patient demographic and financial information for registration and accurate claim reimbursement, providing the estimated patient portion at the time of discharge
- Obtained pre-certification/authorization of services as needed
- Advised patients/guarantor as to their liability, and obtained expected payment by collecting copayment, deductible, and/or coinsurance upon discharge
- Assisted in job interviews and evaluation of prospective employees including final recommendation on hiring to Practice Administrator.
Release of INFORMATION COORDINATOR
NORTHSIDE ATLANTA HOSPITAL
03.2007 - 06.2009
- Ensured that the medical information maintains its quality, accuracy, accessibility, and security in both paper files and electronic systems
- Answer telephone, record messages, and update call logs to appropriate department
- Use various classification systems to code and categorize patient information for insurance reimbursement purposes, for databases and registries, and to maintain patients’ medical and treatment histories
- Release information to patients, insurance companies, clinical staff, according to the HIPPA law and guidelines for continuation of care and treatment as well as for business/legal purposes.
PATIENT ACCESS COORDINATOR
TRI-COUNTY PEDIATRICS
01.2004 - 01.2007
- Responsible for proper patient identification, billing information, patient demographics, and registration
- Collected and input all necessary demographic, clinical, billing and insurance information from patients or responsible parties
- Explained processes and forms to patients prior to securing signatures and ensures that all documents are properly signed and witnessed as required
- Determined and accepted required payments, including co-pays and deductibles
- Ensured medical necessity compliance by obtaining necessary data, reviewing compliance system, communicating information to patient or guarantor and obtaining necessary signatures
- Protected financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility.
Education
BACHELOR OF SCIENCE - MANAGEMENT AND HEALTHCARE ADMINISTRATION
ALBANY STATE UNIVERSITY
Albany, GA12-2003
Skills
- Workflow optimization
- Strategic planning
- Process improvement expertise
- Innovation and creativity
- Project management
- Training coordination
- Conflict resolution techniques
- Performance improvements
Timeline
Quality Improvement Specialist
Centene/Peachstate
03.2021 - Current
BUSINESS OFFICE INSURANCE COORDINATOR
NORTHSIDE HOSPITAL
02.2019 - 10.2023
REFERRAL COORDINATOR
KAISER PERMANENTE REGIONAL OFFICE
07.2018 - 01.2019
INSURANCE VERIFICATION & PATIENT ACCOUNT COORDINATOR
ORTHO-ATLANTA
04.2017 - 07.2018
REFERRAL COORDINATOR
THE MEDICAL GROUP
10.2015 - 04.2017
BUSINESS OPERATIONS SUPERVISOR
FIRST GA PHYSICIANS GROUP
01.2014 - 10.2015
FRONT OFFICE COORDINATOR
BIBB MEDICAL CARE
07.2009 - 01.2014
Release of INFORMATION COORDINATOR
NORTHSIDE ATLANTA HOSPITAL
03.2007 - 06.2009
PATIENT ACCESS COORDINATOR
TRI-COUNTY PEDIATRICS
01.2004 - 01.2007
BACHELOR OF SCIENCE - MANAGEMENT AND HEALTHCARE ADMINISTRATION
ALBANY STATE UNIVERSITY