Kemaly Moreland
Richmond
Summary
Resolved insurance disputes and ensured HIPAA compliance, maintaining exceptional customer service and supporting seamless patient care.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Patient Account Representative
Conifer Health
04.2025
- Access payer websites and discern pertinent data to resolve accounts
- Utilize all available job aids provided for appropriateness in Patient Accounting processes
- Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account
- Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership
- Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities
- Provide support for team members that may be absent or backlogged
Prior Authorizations Tier 2 Denials Specialist
Medical Service Company
10.2024 - 04.2025
- Review and dispute authorization denials with insurance providers to secure accurate coverage.
- Submit, track, and manage prior authorization requests in compliance with payer policies.
- Oversee authorization renewals to maintain uninterrupted patient care.
- Consistently exceed performance benchmarks and successfully complete advanced training.
Patient Financial Services Representative
Banner Health
09.2023 - 10.2024
- Provided financial counseling to patients, clarifying billing procedures and insurance claims.
- Streamlined billing and collections processes to improve payment efficiency.
- Conducted follow-ups on outstanding accounts and insurance claims to ensure resolution.
- Assisted cash posting department with account reconciliation and lockbox payments.
Claims Examiner
Allegiance Benefit Plan Management
02.2023 - 09.2023
- Reviewed, analyzed, and processed complex healthcare claims across multiple systems.
- Verified pricing, prior authorizations, and benefits before claim processing.
- Identified and escalated claim/system issues for timely resolution.
- Consistently met quality and productivity benchmarks across multiple lines of business.
Patient Qualification Specialist
Apria Healthcare Sleep Center
01.2021 - 01.2023
- Reviewed patient orders and verified documentation for insurance approval.
- Coordinated authorizations to maximize patient health plan benefits.
- Maintained proactive communication with referral sources to expedite care.
- Built strong relationships with field leadership through collaboration.
Education
Bachelor of Science - Business Administration And Management
Colorado Technical University
Colorado Springs, CO05.2022
Skills
- Applied expertise in ICD-10, HCPCS, and CPT coding to enhance billing accuracy and support healthcare operations
- Achieved timely processing of prior authorizations and claims through effective collaboration Enhanced accuracy of claims submissions, resulting in reduced rework Improved overall claims processing efficiency by implementing best practices
- Streamlined insurance verification procedures, ensuring adherence to HIPAA regulations and safeguarding sensitive data
- Analyzed and improved revenue cycle workflows, ensuring timely billing and collections
- Managed comprehensive data entry and cash posting tasks, ensuring timely and accurate financial documentation
- Implemented conflict resolution techniques to address customer concerns and improve overall service quality
- Streamlined workflows through organized time management and a focus on detail-oriented processes
Accomplishments
Magna Cum Laude
Affiliations
Delta Mu Delta
Certification
CRCR, Certified Revenue Cycle Representative 11.05.23 Expires CERTIFICATIONS
5.31.26 HFMA
CSPR, Certified Specialist Payment & Reimbursement 12.27.23 Expires 5.31.26
HFMA
Timeline
Patient Account Representative
Conifer Health
04.2025
Prior Authorizations Tier 2 Denials Specialist
Medical Service Company
10.2024 - 04.2025
Patient Financial Services Representative
Banner Health
09.2023 - 10.2024
Claims Examiner
Allegiance Benefit Plan Management
02.2023 - 09.2023
Patient Qualification Specialist
Apria Healthcare Sleep Center
01.2021 - 01.2023
Bachelor of Science - Business Administration And Management
Colorado Technical University