Polly Rose
Walton
Summary
Competent Medical Billing Specialist with 25 years of experience in handling wide variety of medical coding and billing tasks. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes. Expertise in accurately inputting procedure and diagnosis codes into billing software to generate invoices.
Overview
26
26
years of professional experience
Work History
Medical Billing Specialist
Pediatric Associates Of Northern Kentucky
Crestview Hills
12.1999 - Current
- Processed and submitted insurance claims for pediatric services, ensuring timely reimbursement.
- Reviewed patient accounts for accuracy, resolving discrepancies to maintain billing integrity.
- Coordinated with healthcare providers to clarify billing inquiries and enhance service delivery.
- Developed and implemented streamlined billing procedures, improving efficiency in revenue cycle management.
- Analyzed payment trends and denials, identifying areas for improvement to optimize collections process.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Located errors and promptly refiled rejected claims.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Identified and resolved patient billing and payment issues.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Maintained strong working relationships with healthcare providers, fostering clear communication regarding billing-related matters.
- Managed patient accounts effectively, resolving discrepancies and addressing outstanding balances in a timely manner.
- Enhanced revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Served as a subject matter expert on medical billing matters, providing guidance to colleagues on complex cases or unique situations.
- Participated in departmental meetings, sharing insights and ideas for improving overall medical billing efficiency and revenue generation.
- Reduced errors in medical billing by meticulously reviewing patient records and ensuring accurate coding.
- Collaborated closely with the clinical team to ensure proper documentation was obtained for accurate billing purposes.
Behavior Health Coordinator
Pediatric Associates Of Northern Kentucky
01.2019 - 05.2025
- Coordinated health programs to enhance patient engagement and access to services.
- Developed training materials for staff on compliance and best practices in health coordination.
- Managed scheduling and logistics for multiple health initiatives simultaneously.
- Streamlined communication between healthcare providers and patients to improve service delivery.
- Analyzed patient feedback data to identify areas for program improvement and resource allocation.
- Conducted regular assessments of patient needs and coordinated services accordingly with relevant healthcare professionals.
- Served as a liaison between patients, families, and healthcare providers to ensure seamless transitions across different levels of care.
- Established a patient-centric approach to care coordination, resulting in increased satisfaction and improved health outcomes.
- Enhanced patient satisfaction by implementing personalized health education programs and resources.
- Increased provider participation in continuing education opportunities by organizing relevant workshops, webinars, or seminars.
- Scheduled surgeries, managed pre-certifications and verified insurance coverage.
- Defined testing protocols, quality assurance initiatives and clinic policies and procedures.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Communicated with patients, ensuring that medical information was kept private.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
Education
High School Diploma -
Connor High School
Hebron, KYSkills
- Payment posting
- Claim submission
- HIPAA compliance
- Insurance verification
- ICD-10 proficiency
- Medical billing
- Insurance claims
- ICD-10 coding
- Electronic claims
- CMS-1500 billing forms
- Electronic health record software
- Patient collections
- Account reconciliation
- Knowledge of Availity, InstastaMed
- Office Practicum software
- General accounting functions, google sheets, excel, Microsoft word applications
Timeline
Behavior Health Coordinator
Pediatric Associates Of Northern Kentucky
01.2019 - 05.2025
Medical Billing Specialist
Pediatric Associates Of Northern Kentucky
12.1999 - Current
High School Diploma -
Connor High School