KIMBERLY SOMERS
Peabody
Summary
Detail-oriented professional with excellent communication, interpersonal, and creative thinking skills. Frequently praised as hardworking by my peers and employers. I can be relied upon to help your company achieve its goals, with over 20 years of experience in medical insurance and 7 years with denials. Results-driven Denial Specialist known for productivity and efficiency in task completion. Specialize in claims analysis and the appeal process. Excel in communication, problem-solving, and time management, leveraging these skills to navigate complex denial cases successfully.
Overview
21
21
years of professional experience
Work History
Denial Specialist/Hospital & Professional Billing
Beth Israel Lahey Health
Beverly
10.2018 - Current
- Conducted claims research and collaborated with insurance companies to rectify denied claims.
- Prepared appeals and reconsideration requests for payment recovery on disputed claims.
- Managed work queues focused on correcting registration errors to ensure clean claims submission.
- Resolved patient billing inquiries related to insurance issues through effective communication.
- Updated insurance information on registrations to correct inaccuracies.
- Obtain, verified and enter insurance authorizations and referrals to streamline patient care.
- Assigned providers to newly admitted patients, ensuring appropriate coverage and continuity of care.
- Analyzed claims to identify denial reasons and patterns.
- Documented denial trends and recommended process improvements.
- Reviewed and analyzed denied claims to determine reasons for denial and identified corrective actions.
- Utilized critical thinking skills to evaluate denial patterns and recommend process improvements.
- Prepared and submitted appeal letters and necessary documentation to overturn unjustified denials.
- Organized information by using spreadsheets, databases or word processing applications.
Emergency Department Patient Access Representative
Beth Israel Lahey Health
06.2004 - 09.2018
- Greeted incoming patients, assessing visit severity for appropriate care prioritization.
- Maintained calm and informed environment for patients in waiting room.
- Trained and mentored new employees to enhance team performance.
- Assigned beds to newly admitted patients, ensuring proper hospital placement.
- Created patient charts and registered existing patients, verifying accurate financial and demographic information.
- Obtained signatures for financial responsibility and treatment from patients and guardians.
- Communicated patient status, concerns, and complaints to nursing staff and management.
Education
Associate of Arts -
Eastern Nazarene College
Quincy, MASkills
- Multitasking and time management
- Attention to detail
- Communication skills
- Organizational skills
- Team collaboration
- Meditech and EPIC proficiency
- Microsoft Office expertise
- Insurance website navigation
- Claims research and analysis
- Appeals preparation
- Insurance verification
Timeline
Denial Specialist/Hospital & Professional Billing
Beth Israel Lahey Health
10.2018 - Current
Emergency Department Patient Access Representative
Beth Israel Lahey Health
06.2004 - 09.2018
Associate of Arts -
Eastern Nazarene College
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