- Community Cleanup
- Gardening
- Participating in cultural exchange programs and homestays
- I enjoy helping others and giving back to the community
- Offering time and support to shelters for the homeless, women, and animals
- Cooking
- Volunteering
- Fundraising Events
- Crafting and DIY Projects
- I like trying new recipes and food trends
- Homelessness Outreach
Kathy Fuller
Candler,NC
Summary
Dynamic Medical Claims Specialist with extensive experience at Sisters of Mercy Urgent Care, adept in claims processing and insurance verification. Proven track record of reducing errors and expediting claim resolutions while delivering exceptional customer service. Skilled in Medicare regulations and EOB analysis, ensuring compliance and maximizing reimbursements.
Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously.
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate systems. Effective at operating within regulations and department guidelines to manage telephone calls, emails, letters and in-person requests for assistance.
Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.
Overview
25
25
years of professional experience
Work History
Medical Claims Specialist
Sisters of Mercy Urgent Care
07.2023 - Current
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Improved claim processing efficiency by streamlining workflows and implementing best practices.
- Assisted in the development of policies and procedures related to medical claims management, ensuring compliance with industry regulations.
- Identified opportunities for cost savings by analyzing medical billing patterns across various departments.
- Effectively resolved claim disputes by conducting thorough investigations and presenting findings to stakeholders clearly and concisely.
- Submitted electronic/paper claims documentation for timely filing.
- Managed high volume of claims, consistently meeting deadlines without compromising accuracy or quality.
- Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.
- Optimized workflow processes by identifying bottlenecks within the system, implementing necessary changes for increased efficiency.
- Skillfully navigated Medicare/Medicaid regulations in order to secure maximum reimbursement rates for qualifying services provided.
- Monitored outstanding accounts receivable balances for trends that could indicate payer issues or potential collection problems.
- Achieved timely reimbursements for clients through keen understanding of insurance company protocols.
- Verified patient insurance coverage and benefits for medical claims.
- Checked documentation for accuracy and validity on updated systems.
Resident Assistant
ABCCM
03.2021 - 01.2025
- Attended, participated, and contributed to monthly staff meetings addressing resident needs.
- Served as an approachable resource for residents seeking advice or assistance with personal or academic issues.
- Responded to room transfers, incident reports, and maintenance requests.
- Managed front desk operations during assigned shifts, assisting visitors with inquiries while maintaining accurate records of residence hall activities.
- Maintained clean, safe, and well-organized patient environment.
- Monitored and inspected residence hall rooms to determine safety and manage maintenance issues.
- Conducted regular room inspections to ensure adherence to residence hall policies, maintaining a clean and organized living environment.
- Mentored new Resident Assistants, providing guidance on effective strategies for managing various situations.
- Established and enforced residence hall policies and quiet hours to establish safe and respectful living environment.
- Ensured safe living environment, conducting regular safety checks and promptly addressing any violations.
Medical Claims Specialist
Mission Hospital Regional Medical Center
09.2000 - 09.2017
- Collaborated with interdisciplinary teams to ensure smooth processing and accurate reimbursement of medical claims.
- Monitored outstanding accounts receivable balances for trends that could indicate payer issues or potential collection problems.
- Negotiated payment plans for patients facing financial hardships, minimizing revenue loss while maintaining empathetic customer service.
- Skillfully navigated Medicare/Medicaid regulations in order to secure maximum reimbursement rates for qualifying services provided.
- Developed strong relationships with healthcare providers to facilitate efficient information exchange regarding patient eligibility and benefits coverage.
- Achieved timely reimbursements for clients through keen understanding of insurance company protocols.
- Verified patient insurance coverage and benefits for medical claims.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Managed large volume of medical claims on daily basis.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Responded to correspondence from insurance companies.
- Processed and recorded new policies and claims.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Patient Account Representative
Department of Veterans Affairs
09.2009 - 07.2017
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
- Ensured compliance with healthcare regulations while processing claims and managing patient accounts.
- Identified trends in unpaid accounts, developing targeted solutions for improved revenue recovery.
- Maintained accurate records of all transactions, ensuring timely payments from patients and insurance providers.
- Prepared reports detailing billing actions, flags, and other key information.
- Developed strong relationships with key contacts at insurance companies to expedite resolution of claim disputes or other account-related issues.
- Researched billing errors and discrepancies to initiate corrective action.
- Responded to customer inquiries and provided detailed account information.
- Established relationships with customers to encourage payment of delinquent accounts.
Education
High School Diploma -
Enka High School
Candler, NC06-1971
Skills
- Medicare expertise
- ICD-10 proficiency
- Claims processing
- Insurance verification
- Medicaid
- Claim appeals handling
Interests
Timeline
Medical Claims Specialist
Sisters of Mercy Urgent Care
07.2023 - Current
Resident Assistant
ABCCM
03.2021 - 01.2025
Patient Account Representative
Department of Veterans Affairs
09.2009 - 07.2017
Medical Claims Specialist
Mission Hospital Regional Medical Center
09.2000 - 09.2017
High School Diploma -
Enka High School
Similar Profiles
CAROLINE COXCAROLINE COX
Radiographic Technologist at Mercy Health Urgent CareRadiographic Technologist at Mercy Health Urgent Care
James CarltonJames Carlton
Certified Clinical Medical Assistant at Mercy West Urgent CareCertified Clinical Medical Assistant at Mercy West Urgent Care
Amy BomaritoAmy Bomarito
Registered Medical Assistant at Mercy Go Health Urgent CareRegistered Medical Assistant at Mercy Go Health Urgent Care
Morgan GroomsMorgan Grooms
6th Grade ELA Teacher at Koontz Intermediate, Buncombe County Schools6th Grade ELA Teacher at Koontz Intermediate, Buncombe County Schools
Dayanka GudgerDayanka Gudger
Exceptional Children Teacher's Assistant at Buncombe County SchoolsExceptional Children Teacher's Assistant at Buncombe County Schools