Karine Saintvil
@karinesaintvil
Customer service-oriented professional with medical billing expertise.
What I'm looking for
I am a dedicated professional with a strong background in medical billing and claims processing. My experience spans over a decade, during which I have honed my skills in managing accounts receivable, resolving discrepancies, and ensuring compliance with HIPAA regulations. I pride myself on my ability to communicate effectively with clients, providers, and insurance payers, facilitating a smooth billing process.
Throughout my career, I have successfully worked in various roles, including Denial Analyst and Claims Processor, where I have demonstrated my problem-solving abilities by addressing claim denials and appeals. My attention to detail and commitment to maintaining organized records have contributed to my success in achieving high-quality billing services. I am passionate about leveraging my expertise to support healthcare organizations in optimizing their revenue cycle management.
Experience
Work history, roles, and key accomplishments
Denial Analyst
Revecore
Aug 2024 - May 2025 (9 months)
Requested additional information from insurance carriers and members as needed. Maintained company production and quality standards. Maintained organized records of all billing transactions and correspondence.
Claims Processor
United Healthcare Group
Sep 2022 - Apr 2024 (1 year 7 months)
Reviewed and adjudicated medical claims based on health policy provisions and guidelines. Finalized and posted payments and followed up on claims needing additional information to determine medical necessity. Identified root causes and trends in claim denials and took necessary steps to prevent future denials.
Claim Associate
State Farm
Aug 2019 - Dec 2021 (2 years 4 months)
Worked as part of a team and applied knowledge of medical terminology to handle simple and complex claims. Researched denials and entered data into computer systems. Finalized and posted payments for claims and completed Medicare and Medicaid compliance reporting.
Appeals Coordinator
McBee Associates
Sep 2015 - Jul 2019 (3 years 10 months)
Oversaw various cases including provider payment disputes, medical appeals, and reversals. Completed data entry of all new denied cases and researched reasons for denials. Placed outbound phone calls to providers and followed up via email or letters.
Managed Care Coordinator
Horizon Blue Cross Blue Shield of New Jersey
Mar 2004 - Jul 2015 (11 years 4 months)
Prepared, documented, and routed cases in appropriate system for clinical review. Initiated call-backs and correspondence for members and providers to coordinate and clarify benefits. Handled Explanation of Benefits (EOB), processed claims accurately, resolved billing issues, and provided insurance providers with correct payments.
Education
Degrees, certifications, and relevant coursework
Ultimate Medical Academy
Associate of Science Degree, Medical Billing and Coding
Completed an Associate of Science Degree in Medical Billing and Coding. Gained expertise in medical insurance claims, billing services, and revenue cycle management. Developed skills in problem-solving, communication, and compliance with healthcare regulations.
Ultimate Medical Academy
Certificate, HIPAA Essentials for Healthcare Professionals
Obtained a HIPAA Essentials for Healthcare Professionals Certificate. Focused on understanding and adhering to HIPAA compliance standards in healthcare settings. Enhanced knowledge of patient privacy and data security.
Tech stack
Software and tools used professionally
Availability
Location
Authorized to work in
Job categories
Interested in hiring Karine?
You can contact Karine and 90k+ other talented remote workers on Himalayas.
Message KarineFind your dream job
Sign up now and join over 100,000 remote workers who receive personalized job alerts, curated job matches, and more for free!
