LESLIE SPALDING
Lexington,Kentucky
Summary
Experienced Patient Financial Services and Medical Billing professional with 15+ years of experience in healthcare revenue cycle, insurance claims processing, patient accounts, and customer service. Proven ability to resolve rejected and pended claims, communicate effectively with insurance companies and patients, and maintain accurate electronic health records.
Overview
18
18
years of professional experience
Work History
Patient Financial Services Representative
University of Kentucky, Patient Accounts
Lexington, KY
03.2020 - Current
- Managed high-volume UB-04 claim denials, conducting thorough root cause analysis to reduce future rejections. Resolved complex claim processing difficulties by collaborating with insurance carriers and internal departments.
- Corrected registration errors and adjusted account data, accelerating reimbursement turnaround times.
- Trained new staff on departmental protocols and systems, fostering a knowledgeable workforce.
- Promoted a positive patient experience, addressing concerns and resolving issues related to billing or insurance coverage.
Patient Relations Assistant
University of Kentucky, Internal Medicine
Lexington, KY
07.2016 - 03.2020
- Managed front-desk operations, including registration, insurance verification, and high-volume scheduling.
- Managed patient scheduling, ensuring optimal appointment availability and minimizing wait times.
- Provided support in handling patient inquiries, fostering a welcoming environment for visitors.
- Maintained accurate patient records using electronic health record (EHR) systems to ensure data integrity.
- Served as a point of contact for patient concerns, addressing issues promptly and effectively.
Patient Account Analyst
Lexington Clinic
Lexington, KY
04.2014 - 07.2016
- Reviewing claims denial on CMS-1500, and submitting charges to insurance companies for accounts; investigate and resolve all rejected and pended claims received; respond timely to patient inquiries regarding account status; make account adjustments and corrections; communicate with insurance representatives and/or patients to resolve processing difficulties; correct registration errors
Claims Analyst
SIHO
Columbus, IN
10.2012 - 02.2014
- Processed and reviewed incoming medical, pharmacy and dental claims; applied appropriate health plan benefits and updated claims for payment; acted as a resource for questions, problems and researched issues for internal and external customers; assisted in departmental reporting
Customer Service Representative
Indiana Farm Bureau
Columbus, IN
06.2010 - 10.2012
- Provided prompt and courteous service to clients and potential clients; Managed multiple customer accounts for two agents; Set up and modified new and existing billing accounts and assisted with billing issues; Licensed to write new auto and home insurance policies
- Educated clients on available services and products to enhance customer satisfaction.
- Responded to customer requests for products, services, and company information.
Member Services
SIHO
Columbus, IN
04.2008 - 06.2010
- Customer service phone support; quoted medical benefits, eligibility and provided explanation of benefits; Helped insured and medical providers with claims issues
- Assisted in developing training materials for staff on best practices related to member services delivery, enhancing team performance overall.
- Assisted in training new Member Services Representatives, sharing best practices for handling complex inquiries.
Education
Associate of Arts - General Studies
Eastern Kentucky University
Richmond, KY08.2008
Diploma in Medical Billing And Coding
National College of Business And Technology
Lexington, KY2008
Skills
- Denial Management & Resolution: Experience researching, managing, and overturning denied claims, particularly in commercial insurance healthcare billing with both facility and physician claims
- Coding & Billing Knowledge: Proficiency in ICD-10, CPT-4, and HCPCS coding, as well as understanding HCFA-1500 or UB-04 forms
- Technical Proficiency: Familiarity with Electronic Health Records (EHR) systems, denial management software such as EPIC and MS Office
- Analytical & Communication Skills: Ability to identify trends in denied claims and communicate complex issues to insurance companies to secure payments
- Friendly, professional attitude; team and individual oriented; ability to learn quickly; highly organized; pays attention to detail; works well under deadlines
Timeline
Patient Financial Services Representative
University of Kentucky, Patient Accounts
03.2020 - Current
Patient Relations Assistant
University of Kentucky, Internal Medicine
07.2016 - 03.2020
Patient Account Analyst
Lexington Clinic
04.2014 - 07.2016
Claims Analyst
SIHO
10.2012 - 02.2014
Customer Service Representative
Indiana Farm Bureau
06.2010 - 10.2012
Member Services
SIHO
04.2008 - 06.2010
Diploma in Medical Billing And Coding
National College of Business And Technology
Associate of Arts - General Studies
Eastern Kentucky University