Kimberly M. Walker2951 Stanley Road, Fairlawn OH 44333

330-510-6292 Kimwal413@gmail.com

Focused and innovative professional seeking a challenging position within a progressive organization in which professional development, career growth, and personal satisfaction are key center aspects.

Selected Software Skills CPT/ICD-9/ICD-10 knowledge Extensive Medical and Dental Insurance Knowledge HIPAA Privacy Policies Amisys System-Advanced SQL/Oracle Microsoft Office Products (Word, Excel, Access, Outlook) Macess Document System Typing 60-65 wpm

PROFESSIONAL EXPERIENCE

Manager, Configuration, SummaCare, Inc., Akron, Ohio Jan. 2016 to Dec., 2016 Manages Insurance Benefit Configuration staff and Provider Configuration staff to support training,

payroll, time off requests, auditing and day-to-day activities of department.   Manages development and implementation of all medical insurance benefit and provider configuration to

ensure process and performance improvements. Provides leadership, training, and guidance to configuration staff while providing feedback to staff in

regards to audits and production findings. Mentors staff to work with internal and external customers to ensure agreed upon system requests,

implementation requirements are understood and met by all parties; while ensuring work is appropriately project managed and delivered on time and with quality results.

Leads overall project execution, financial control and effectiveness in areas of configuration management and monitoring. This includes tools crossing several suites of products including but not limited to Amisys..

Configuration Coordinator, SummaCare, Inc. Akron Ohio Aug 2012 to Jan., 2016 Coordinated various facets of the Configuration department including development, teaching, and training

staff Assumed various management responsibilities including staff recruiting, natural progression forms and

PTO requests Consulted with other business leaders to respond to department issues and concerns. Aligned the department with cross training and training guides Communicated consistently and proactively with team members via one on one meetings, emails and

coordinated meeting notes and helped coordinate individual work plans Conduct audits of operational data consistent with policies and procedures New group implementation, yearly data loads, and plan maintenance for HMO, PPO, POS, Medicare and

Medicaid Medical Insurance Plans. Review Summary Plan Benefits, Schedule of Benefits and Implementation Guides for all Lines of Business

to develop and create medical benefits for medical claims payment Handles various updates via SQL and Oracle Queries

Configuration Specialist II, SummaCare, Inc., Akron, Ohio Jan. 2011 to Aug., 2012 Deliver configuration support within new subsystems, benefits, and provider contracts Confirm contractual agreements and internal policies Develop and provide reports within medical benefits to end-users

Config Tech II, SummaCare, Inc., Akron, Ohio      July, 2009 to Jan., 2011 Insurance Benefit Plan testing in order to verify claims payment accuracy. Creation and completion of testing scripts for new group implementation, system upgrades, and new

software Database creation to support other areas within the company

Claim Processor, SummaCare, Inc., Akron, Ohio Aug., 2007 to July, 2009 Processed all types of claims, promptly and accurately, as assigned via the Docflo Queues Ensures self-funded service standards, prompt pay standards, and regulatory requirements were met Handled special projects within time frames established/assigned by manager

Claims Analyst, Klais & Company Inc. Akron, Ohio Sept., 2005 to Aug., 2007 Reviewed, analyzed and processed University Medical Insurance Claims relating to various        levels of medical benefits Reviewed provider and enrollee appeals regarding processed claims Handled extensive incoming telephone inquiries with insurers, providers and clients regarding medical

benefits

Overpayment Specialist, Aetna Health Plans, Akron, Ohio July, 1994 to Sept.,2005 Processed all types of claims, promptly and accurately   Promoted to overpayment specialist review internal audits and sending out collection notices to medical

providers Knowledge of every insurance plan Aetna was contracted with

Accounts Receivable Clerk, Roberts Express, Akron, Ohio May, 1992 to July, 1994 Approved new customers on a Dunslink System Audited freight bills Posted weekly and monthly payments Reviewed weekly and monthly ledgers Worked with Collections department to collect customer past due amounts. Deny customers pick-ups and deliveries if account was delinquent.

EDUCATION

University of Akron, Akron OH 1989 - 1992Major:  Political ScienceCertifications: Lean Sigma Six, - Yellow Belt, Datasphere; Amisys Advance - Benefits Management Subsystem, Pricing Management Subsystem, Liability Recovery Subsystem; HIAA – Health Insurance Association of American Parts A & B; ICA – International Claims Association Part A, Medical Terminology