Kelly Bush
@kellybush
Detail-oriented Medical Billing and Insurance Analyst with extensive experience.
What I'm looking for
I am a dedicated Medical Billing and Insurance Analyst with a strong background in healthcare claims management and customer service. My experience spans various roles, including Medical Biller and Grievance Analyst, where I have consistently demonstrated my ability to manage complex billing processes and ensure compliance with industry standards.
Throughout my career, I have developed a keen eye for detail, achieving 100% accuracy in claims processing and improving team metrics through effective collaboration and innovative problem-solving. My proficiency in medical billing software and tools, combined with my commitment to customer satisfaction, has enabled me to excel in fast-paced environments.
I am passionate about leveraging my skills to contribute to a team that values precision and efficiency in healthcare administration. I thrive in roles that challenge me to utilize my analytical abilities while fostering a culture of teamwork and continuous improvement.
Experience
Work history, roles, and key accomplishments
Medical Biller
SMB Billing LLC
Jun 2024 - Present (1 year 1 month)
Completed charge entry, billing, and insurance follow-up tasks for Wound Care and Ostomy Supplies. Entered an average of 80 orders per day using TeamDME Software, reviewing chart notes to abstract diagnosis and wound count information.
Healthcare Claims Keying Consultant
Hays, Cognizant
Jan 2025 - Present (6 months)
Keyed backlog claims at 100% accuracy for the duration of a 3-month project, making effective use of business applications while maintaining a sense of urgency. Accurately keyed claims into Facets Interactive business application, assisting in the claims aspect of the Cognizant - TMG Health merger.
Grievance Analyst, Priority Health Plan
Corewell Health
Jun 2024 - Present (1 year 1 month)
Worked on a team of 5 Grievance Analysts, consistently upholding CMS guidelines for timeliness when working assigned cases. Audited raw data samples of accepted grievances and conducted analysis on dis-enrollment requests.
Grievance Analyst, Cigna Medicare Prescription Drug Plan
Convey Health Solutions
Sep 2023 - Present (1 year 10 months)
Researched member plan benefits using various Medicare-related tools, including the ESI Evernorth portal and Medicare Enrollment Reconciliation Files. Improved documentation standards by developing a notepad of grievance resolution verbiage and working with management to draft new letter templates.
Resolution Specialist - Claims Processor
United Healthcare
Jun 2011 - Present (14 years 1 month)
Reviewed claims data against applicable payer reimbursement policy, analyzing CPT, HCPC, and ICD-10 codes to ensure appropriate reason codes were attached to remittances. Verified patient credit balances for coordination of benefits and reworked claims using an Excel calculator to confirm accurate offsets.
Education
Degrees, certifications, and relevant coursework
Hays, Cognizant
Bachelor in Healthcare Claims Management, Healthcare Claims Management
Activities and societies: Engaged with team members, mentors, and team lead to ask questions, identify gaps in Excel spreadsheet data/ formatting, and provide second set of eyes when needed.
Keyed backlog claims at 100% accuracy for the duration of the 3-month project. Made effective use of business applications provided, while maintaining a sense of urgency. Accurately keyed claims into Facets Interactive business application, assisting in the claims aspect of the recent Cognizant - TMG Health merger.
Temple University
Master of Science in Health Services Administration, Health Services Administration
Activities and societies: Communicated effectively among team members, collaborating on ways to resolve grievances accurately. Utilized various digital tools such as Microsoft Teams, Outlook, Excel, Google Drive, and Salesforce to share information. Used Facets Subscriber/ Member function for generating letters to Plan members. Gained familiarity with Delta Dental, ESI Evernorth, EviCore and Altruista Guiding Care online portals.
Worked on a team of 5 Grievance Analysts, consistently upholding CMS guidelines for timeliness when working assigned cases. Audited a raw data sample of accepted grievances filed against Priority Health Medicare Part C and D Plans, keeping a customers first mentality and conducting analysis on dis-enrollment requests.
D'Youville College
Certificate in Medical Billing and Coding, Medical Billing and Coding
Activities and societies: Improved team metrics by meeting and exceeding individual goals and having perfect attendance.
Used various Medicare related tools, including ESI Evernorth portal and Medicare Enrollment Reconciliation Files, to research member plan benefits. Improved the documentation standard on the team by developing a notepad of grievance resolution verbiage for common grievance scenarios and working with management to draft new letter templates.
United Healthcare
Resolution Specialist - Claims Processor, Claims Processing
Activities and societies: Consistently achieved top performer award per quarter, and acted as a mentor to my team by answering SME SharePoint questions.
Reviewed claims data against applicable payer reimbursement policy. Analyzed CPT, HCPC and ICD-10 codes, and ensured that the appropriate reason code(s) was attached to remittance. Verified patient credit balances for coordination of benefits and rework claims, using an Excel calculator, to confirm that any offsets due were accurate.
Tech stack
Software and tools used professionally
Availability
Location
Authorized to work in
Job categories
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