Kimberly Holmes
St Louis
Summary
Versatile Medical Professioal with 25+ years of extensive coding, billing, auditing, compliance and credentialing experience leveraging CPC, ICD-10/ICD-9, CPT, and Epic to reduce denials and strengthen compliance. Skilled in clinical audit, provider credentialing workflows, and training that improve documentation quality, accelerate collections, and maintain licensure continuity. Focus is on process improvement and accurate revenue-cycle operations, seeking to apply analytical auditing and credentialing expertise to enhance compliance and financial performance.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Coding Quality Assurance Specialist
Privia Health
01.2024 - Current
- Educated employees on specific QA standards and confirmed maintenance of standards.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Assist in development and ongoing maintenance of processes and procedures for each assigned client
- Conducted data review and followed standard practices to find solutions.
- Perform quality assessments of coders completed work to validate standards are met
- Follow coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
- Collaborate with internal Privia+ and Privia teams
Compliance Auditor/Claims Review Analyst
Barnes Jewish Hospital- Washington University School of Medicine
06.2022 - 10.2023
- Prepared reports for templates and maintained compliance database.
- Analyzed all audit results and resolved all compliance issues.
- Participated in various training and development programs.
- Ensure standards are met in accordance with department and organization policy. Including contributing to improving the processes and infrastructure of the department.
- · Review medical records and other documentation to identify under and over-coded services, prepare reports of findings and meets with management to educate.
Medical Coder/Biller/Credentialing Assistant
SSM St Louis University Hospital
09.2010 - 06.2022
- Maintains credentialing databases and ensures timely license renewals to prevent provider downtime as support for Provider Credentialing and Resident teams.
- Audits medical records for ICD and CPT-4 compliance, reducing coding discrepancies and claim denials.
- Codes and bills inpatient, outpatient, SNF, surgery, and VA claims with specialty-specific accuracy.
- Delivers coding training to physician staff to improve billing accuracy and documentation quality.
- Provided ongoing training and updates to physician staff, fostering a collaborative environment that enhanced coding proficiency across the team.
- Maintained meticulous documentation of coding changes and compliance audits, ensuring adherence to government regulations and internal guidelines.
- Advocated for best coding practices during departmental meetings, contributing to a culture of excellence and continuous improvement in billing operations.
Regional Business Office Manager
Stearns Nursing and Rehabilitation
12.2010 - 09.2011
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
- Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
- Updated reports, managed accounts, and generated reports for company database.
- Resolved financial discrepancies and customer billing issues with timely attention.
- Managed special projects ensuring compliance with delegated and non-delegated health plan rules and timely completion.
- Coordinated and prepared management reports that improved decision-making with measurable results.
- Reduced accounts receivable to target by enforcing timely collections and follow-up procedures.
- Processed Medicaid applications to secure approvals and reduce payment delays, improving cash flow.
- Reconciled daily census and cash receipts to maintain accurate financial reporting and audit-ready trust reconciliations.
- Conducted thorough audits of resident trust funds, ensuring compliance and maintaining accurate financial records for audit readiness.
- Coordinated management reports that provided actionable insights, leading to informed decision-making and enhanced operational performance.
Medical Practice Office Manager
Mid-County Urology, Inc
05.2009 - 12.2010
- Managed provider credentialing and payer enrollment workflows ensuring timely license renewals and compliance.
- Streamlined charge entry and coding processes to reduce claim rejections and improve billing accuracy.
- Implemented payment posting and AR analyses to accelerate collections and resolve revenue cycle issues.
- Developed billing procedures and clinical documentation guides to improve coding completeness and audit readiness.
- Conducted thorough audits of billing procedures, leading to measurable improvements in coding accuracy and reduced claim denials.
- Fostered a collaborative environment by training staff on updated coding guidelines, promoting teamwork and shared knowledge.
Program Manager, Medical Billing & Coding Program
Allied College
03.2004 - 11.2006
- Coached team members on productivity strategies to accomplish challenging goals.
- Addressed and resolved technical, financial, and operational concerns by working with team members and directors.
- Interacted with customers and clients to identify business needs and requirements.
- Met with project stakeholders on regular basis to assess progress and make adjustments.
- Led hiring and training for faculty and staff, reducing vacancy time and improving team readiness.
- Managed annual budget and inventory to maintain program continuity and control costs.
- Updated and maintained curriculum and course materials to align with coding certification standards.
- Coordinated student externship placements and employer relationships to improve placement outcomes.
- Coordinated with externship sites to ensure optimal student placements, resulting in strengthened industry partnerships and increased job opportunities.
- Developed engaging instructional materials, improving student retention and understanding of complex medical billing concepts for front and back office procedures.
Education
No Degree -
• Saint Louis University
St Louis, MOBusiness Writing
Saint Louis Community College
St. Louis, MO01-2000
Certified Medical Assistant -
Pima Medical Institute
04-1995
No Degree - General Provider Office Secretary
Green River Community College
Auburn, Washington, WA10-1990
Skills
- Training and coaching
- Operations management
- Skills in confirming credentials with primary sources like licensing boards
- Staff development
- Proficiency in drafting and managing correspondence with providers and agencies
- Ability to identify and resolve issues that arise during the credentialing process
- Skills in prioritizing tasks to meet deadlines and manage multiple applications
Accomplishments
- Understand the end-to-end credentialing process for providers
- Identify documentation required from clinicians for credentialing applications and understand the credentialing and re-credentialing process
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Skills in organization, prioritization, professionalism, and coaching others.
- Physician Education and Coder Education Experience. Providing education and finding feedback individually and in group settings.
- learn the end-to-end credentialing process of all providers for payers including the application process and tracking processes for maintaining the credentialing over time.
Certification
AAPC Certified Professional Coder (CPC)
AAPC Certified Physician Practice Manager (CPPM)
AAPC Certified Professional Compliance Office (CPCO)
AAPC Certified Professional Medical Auditor (CPMA)
Timeline
Coding Quality Assurance Specialist
Privia Health
01.2024 - Current
Compliance Auditor/Claims Review Analyst
Barnes Jewish Hospital- Washington University School of Medicine
06.2022 - 10.2023
Regional Business Office Manager
Stearns Nursing and Rehabilitation
12.2010 - 09.2011
Medical Coder/Biller/Credentialing Assistant
SSM St Louis University Hospital
09.2010 - 06.2022
Medical Practice Office Manager
Mid-County Urology, Inc
05.2009 - 12.2010
Program Manager, Medical Billing & Coding Program
Allied College
03.2004 - 11.2006
No Degree -
• Saint Louis University
Business Writing
Saint Louis Community College
Certified Medical Assistant -
Pima Medical Institute
No Degree - General Provider Office Secretary
Green River Community College