Kimberly T Dues

Kimberly T Dues is highly versatile and hardworking professional, offering first-rate organizational and communication skills, combined with unmatched knowledge in all aspects of medical and insurance billing. Received recognition for notable diligence and detail-oriented approach in performing accounting and finance responsibilities. Excel at directing and coordinating cross-functional teams to achieve solid business results. Seamlessly establish and maintain long-term relationships with all departments; able to multitask in high-stress and fast-paced work environments, with dedication to achieve quality monthly/yearly outcomes.

Skills:

• Current Procedural Terminology (CPT) codes
• Handling and processing of government a/o commercial claims
• Performed coding Audits; Revenue Audits; Compliance Audits
• Utilized CMS, Medicaid, Workers Comp, and Private Payer guidelines

Experience:

• Utilize interpersonal skills in coordinating with clients on updates of monthly reports, invoices, credentialing processes, fee schedules, and other concerns.
• Familiarize providers and clients with various information and processes of International Classification of Disease (ICD-9); begin the discussions of (ICD-10) and Current Procedural Terminology (CPT) codes as it relates to reimbursement along with yearly changes.
• Fully adhere to the set of procedures and rules stated in Local Medical Review Policies (LMRP) regarding handling and processing of government a/o commercial claims.
• Render high level of assistance to patients by keeping them up-to-date with their claims balances, managing aged claims, and significantly lessening their accounts receivable.
• Skillfully streamline a wide array of medical billing duties involving demographic entry, payment posting and adjustment, patient statements, paper and electronic claims, claim follow-ups, practice mgt. system table clean-up, etc.
• Gather documents and medical records necessary for claims appeals that would support denied or rejected claims; assess and interpret medical record for resubmission of corrected claims.
• Worked independently in selling life, accident and health insurance products along with securities to individual and business clients.
• Rendered assistance to clients on various insurance processes, including Self Funded Health Plans and their management.
• Performed duties of remote outsourced coding. Ten years consecutive Anesthesia coding; Seven years Pain Mgt Coding.  Two/Three years coding of the following: Neurology, OBGYN
• Laboratory, Ambulance, Gen. Surgery, Physical/Occupational Therapy, Chiropractic, IDTF. 
• Provided functional supervision on examining and auditing insurance contracts for payment, coding methodology, and state prompt pay laws.
• A/R account management.  Posting payments via manual post/ERA, balancing with client’s CPA @ month end.  Strive to resolve each claim balance to ensure accuracy of financial class.
• Utilized CMS, Medicaid, Workers Comp, and Private Payer guidelines for the analyses and auditing of claims for billing and coding accuracy.
• Devised and prepared encounter forms used in billing; studied and interpreted transcription with templates and raw data.
• Performed practice equipment and setup reviews as well as procedures involved in all electronic processes in accordance with Health Insurance Portability and Accountability Act (HIPAA) guidelines.
• Performed coding Audits; Revenue Audits; Compliance Audits.
• Gathered pertinent information on contract reviews, Explanation of Benefits (EOB), fee schedules, coding, modifiers, RVU, MUE, ASA units, ASA time units.
• Initiated the utilization of Electronic HL7 process used for charge capture involving various departments such as inpatient, outpatient, ASC, and office.
• Constantly delivered utmost support and training to staff and BPO in billing procedures, prior authorizations, insurance verifications, co-pay collections, and problem solving as it relates to Revenue Cycle Mgt. and coding.

Licenses:

• LIFE/ACCIDENT/HEALTH
• HEALTH MAINTENANCE ORGANIZATION (HMO)