Karina Taylor
Fort Washington
Summary
With over 12 years of dedicated experience in medical billing across multiple specialties, I bring a proven track record in revenue cycle management and analysis. My journey in healthcare finance has equipped me with an understanding of billing intricacies, the ability to streamline billing processes, and improving revenue cycle efficiency. Excel in managing said processes, coding accuracy, and claims management, ensuring maximum reimbursement. Possess strong skills in strategic planning, team leadership, and healthcare compliance. Strong leadership, analytical, and communication skills.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Accounts Receivable Specialist
Qualderm
09.2024 - Current
- Managed and processed accounts receivable for medical claims, ensuring accurate billing and timely payment collections
- Verified patient insurance information, including verifying eligibility
- Followed up with insurance companies and patients to resolve unpaid claims and billing discrepancies
- Submitted and tracked insurance claims electronically through clearinghouses, ensuring timely submission and proper coding
- Analyzed EOBs and ERAs to identify claim errors or denials and implemented necessary corrections
- Worked with medical providers, insurance carriers, and patients to resolve complex billing and payment issues
- Ensured compliance with federal and state regulations, including HIPAA, to maintain the confidentiality
- Reconciled accounts and managed aging reports to reduce outstanding balances and improve collection rates
- Prepared and submitted appeals for denied claims
- Maintained detailed records of all billing transactions and communications with insurance companies and patients
- Collaborated with the billing team and management to streamline billing processes and improve operational efficiency
Financial Representative
The Wingate Group Inc
03.2024 - Current
- Developed comprehensive business plans tailored for small businesses, integrating insurance solutions to manage risks and enhance financial stability
- Implemented strategic social media campaigns across platforms such as Facebook, Instagram, and LinkedIn to attract and convert leads into clients
- Created engaging content to showcase expertise and services
- Monitored advertising campaigns to target specific demographics, resulting in increased client engagement and conversions
- Analyzed metrics and adjusted strategies to continually improve performance and ROI
- Advise small business owners on insurance products and strategies, ensuring coverage aligned with their operational needs and long term goals
- Conducted financial assessments and formulated personalized retirement planning for individuals, optimizing savings and investment strategies to achieve retirement objectives
- Provided guidance on life insurance solutions, crafting policies that safeguard clients financial futures and protect their loved ones
- Implemented financial planning strategies that encompassed estate planning, investment management, and tax efficiency for high networked individuals
- Collaborated with financial professionals within the firm to come up with the best possible products for clients to add to their financial portfolios
- Conducted regular reviews and updates of clients financial plans to ensure alignment with changing goals and market conditions
- Collaborated with clients to assess current financial health and develop actionable plans to meet short term and long term financial goals.
Licensed Life Insurance Agent
Globe Life - American Income Life
09.2023 - 03.2024
- Life Insurance Agent specializing in the US Veteran market
- Protecting families through will preparation, estate planning, and whole life policies
- Licensed in the states of Pennsylvania, Ohio, Arizona, Alabama, and Virginia.
Revenue Operations Analyst
OPYN Market
11.2021 - 11.2023
- Collaborate with ancillary provider staff to ensure accurate diagnosis and procedure reporting for third-party insurance billing
- Facilitate timely submission of claims via electronic and hard copy methods
- Utilization of the CRM system in conjunction with our other systems and excel spreadsheets to ensure accurate and timely record keeping of claims and patient accounts
- Accept & implement the constant procedural changes of this Start Up company
- Obtain necessary medical documentation as per third-party insurance requirements
- Utilize Daisy Bill in conjunction with the Anthem Marketplace for California workers' compensation cases
- Investigate and resolve intricate billing issues within the automated revenue cycle management system to ensure precision and compliance
- Manage collections for overdue accounts and provide expert assistance to claimants, providers, and clients on claims-related inquiries
- Develop comprehensive expertise in payor billing, revenue cycles, and workflows
- Adhere to departmental standards for timely completion of tasks
- Stay updated on client billing criteria and insurance changes pertinent to assigned responsibilities
- Communicate billing trends and provider behavior insights to leadership for strategic development
- Uphold strict confidentiality of patient and claim information in alignment with company privacy policies
- Proficiency in Microsoft Office Suite including Teams, Word, Excel, PowerPoint, etc.
Medical Billing Manager
Dermatology and Cosmetic Surgery Institute
04.2017 - 11.2021
- Oversight of the billing department across multiple locations within a dynamic medical practice in general and surgical dermatology
- Meticulously reviewed and managed all incoming claim denials, rejections, and invalids, ensuring precision in billing processes
- Applied knowledge of ICD-10 coding, including modifiers and complex billing scenarios such as multiple surgical reductions, to accurately bill surgical and general dermatologic patients
- Successfully appealed wrongfully denied procedures, optimizing revenue recovery and financial outcomes
- Proficiently handled the posting of insurance payments through physical checks or Electronic Funds Transfer (EFT), ensuring timely and accurate posting
- Secured prior authorizations from diverse insurance providers, facilitating seamless surgical billing processes
- Effectively managed insurance and patient accounts receivable, diligently addressing outstanding statements at 30, 60, and 90+ days to maintain financial health
- Engaged proactively with patients to resolve outstanding balances and address inquiries, fostering positive patient relationships
- Managed collections accounting activities, including collaboration with external agencies and ensuring compliance with established protocols
- Skillfully navigated interactions with dissatisfied patients, making informed decisions on patient discharge as needed
- Executed business account banking responsibilities and managed check deposits, ensuring financial operations ran smoothly
- Conducted thorough communications with insurance companies to resolve payment discrepancies promptly and accurately
- Maintained records and upheld confidentiality standards in accordance with HIPAA regulations
- Played a pivotal role as surgical coordinator and scheduler, optimizing patient care coordination and operational efficiency
- Conducted comprehensive insurance verifications and secured PCP referrals when necessary to ensure seamless patient appointments
- Facilitated seamless EMR integration to enhance operational workflows and improve patient care delivery.
Officer Manager
Land Chiropractic
07.2015 - 03.2017
- Scheduled appointments and optimized clinic workflow for efficient patient care
- Conducted thorough insurance verifications to ensure accurate billing and patient coverage
- Maintained detailed and organized patient charts for effective record-keeping and compliance
- Provided patient care, addressing needs and ensuring comfort
- Managed accounts receivables to facilitate timely payment processing and financial stability
- Implemented sanitization protocols to uphold clinic cleanliness and patient safety.
Billing Manager
Dr. Howard Sokol, DDS
01.2013 - 05.2015
- Managed dental billing processes to ensure accurate and timely submission of claims
- Provided attentive patient care, ensuring a positive experience and addressing inquiries
- Implemented effective collections strategies to optimize revenue recovery
- Scheduled appointments efficiently, maximizing clinic productivity and patient satisfaction
- Coordinated supply ordering to maintain adequate inventory levels and reduce downtime
- Administered time card management systems, ensuring accuracy in payroll processing
- Managed accounts receivable to streamline financial operations and maintain cash flow.
Education
High school or equivalent -
Wissahickon High School
06.2011
Skills
- Medical Billing (electronic and CMS 1500)
- Commericial Insurance, Medicare, TriCare, Private Insurance
- ICD-10, CPT Coding
- Medical Records, HIPAA Compliance
- EMR Systems
- Medical Terminology
- Insurance Verification
- A/R Management
- EOBs
- Claims Processing, Claims Review
- Denials, Appeals, Rejections, and Invalid Claim Management
- Payment Posting
- Revenue Cycle Management
- Medical Office Experience
- Data Entry
- Workers' Compensation Knowledge
- Supervising Experience
- Documentation Review
- Prior Authorizations, Pre-Certs
- Microsoft Office Products (Word, Excel, PowerPoint, etc)
- Financial Management
- Office Management
- Communication skills
- Collection Management
- Analytic Skills
- Accounting
Certification
Life & Health Insurance License
PA, AZ, AL, VA, and OH
References
References available upon request.
Timeline
Accounts Receivable Specialist
Qualderm
09.2024 - Current
Financial Representative
The Wingate Group Inc
03.2024 - Current
Licensed Life Insurance Agent
Globe Life - American Income Life
09.2023 - 03.2024
Revenue Operations Analyst
OPYN Market
11.2021 - 11.2023
Medical Billing Manager
Dermatology and Cosmetic Surgery Institute
04.2017 - 11.2021
Officer Manager
Land Chiropractic
07.2015 - 03.2017
Billing Manager
Dr. Howard Sokol, DDS
01.2013 - 05.2015
High school or equivalent -
Wissahickon High School
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