Kimberly Metzger
Hendersonville,TN
Summary
Auditing processes, effective written and verbal communication, organizational, strong analytical and research skills, attention to detail, including claims processing and adjudication with pharmacy help desk. Project Management, time management, Customer relationship management, Windows Office, growth mindset, strategic problem-solving skills to accomplish set company/departmental goals effective
Overview
5
5
years of professional experience
Work History
Patient Care Advocate-PBM/DoD
Express Scripts
01.2022 - Current
- Properly handle and verify patient records under HIPPA and PHI, and secure confidentiality for each call.
- Accept multiple back-to back calls utilizing various applications on multiple screens, and properly enter all patient and provider data.
- Follow the complete formal script pathway with each caller, identifying and transferring any calls that cannot be resolved via the formal script to the appropriate person or department.
- Troubleshoot and process retail pharmacy claim rejections to ensure paid claim.
- Request Rx renewals from prescribers via web base fax.
- Remote
- Analyzed patient feedback to identify service improvement opportunities and enhance overall satisfaction levels.
- Implemented strategies to enhance patient engagement through educational resources and follow-up communications.
Accounts Receivable Specialist
Pinnacle/Loven Dermatology
01.2021 - 01.2022
- Maintained bookkeeping databases and spreadsheets and updated information as needed.
- Managed communication related to patient invoices and incoming bills.
- Communicated with previous clients and customers to request payment and arrange payment plans.
- Collected payments from customers and accurately recording them in the system.
- Created reports and balance sheets that document overall profits and losses.
- Updated client accounts based on payment or contact information.
- Verified claim denials and analyzed patient accounts to correct billing errors.
- Prepared medical records and other necessary documents for timely claim processing.
- Remote
Accounts Receivable Specialist
Ascension St. Thomas
01.2020 - 01.2022
- Maintained bookkeeping databases and spreadsheets and updated information as needed.
- Accurately reviewed ICD10 and CPT codes according to the level of care in patient records.
- Obtained acceptable productivity/quality rates as defined per coding policy.
- Sent requests to physicians when code assignments are not clearly defined for correct billing purposes.
- Conducted chart audits for physician documentation requirements and internal coding.
- Provided associate/physician education as appropriate.
Education
High School Diploma -
Hunters Lane High School
Nashville, TN08-1992
Skills
- Multitasking
- HIPAA compliance
- Organizational skills
- Accounts receivable
- Payment posting
- Claims processing
- Follow-up skills
Timeline
Patient Care Advocate-PBM/DoD
Express Scripts
01.2022 - Current
Accounts Receivable Specialist
Pinnacle/Loven Dermatology
01.2021 - 01.2022
Accounts Receivable Specialist
Ascension St. Thomas
01.2020 - 01.2022
High School Diploma -
Hunters Lane High School
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