Kelly BushKB
Open to opportunities

Kelly Bush

@kellybush

Detail-oriented Medical Billing and Insurance Analyst with extensive experience.

United States
Message

What I'm looking for

I am looking for a role that offers growth opportunities and values teamwork.

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

SL
Current

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.

HC

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.

CS

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.

UH

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

HC

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 logoTU

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 logoDC

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 logoUH

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

Find 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!

Sign up
Himalayas profile for an example user named Frankie Sullivan
Kelly Bush - Medical Biller - SMB Billing LLC | Himalayas