Kimberly T. Dues, CPC, CRC, ICD-10-CM
Certified Risk Adjustment Coder | Healthcare Revenue Cycle Manager
Medical Summation | Commercial & Government Payer
Kim’s experience includes over 24 years in the healthcare field. Her career began as a duly licensed insurance –securities agent in the individual and small business Texas marketplace. She is a subject matter expert on Revenue Cycle Management and currently serves as Regional Director of Texas for BillingParadise 24/7 Inc . BillingParadise 24/7 Inc offers Full Revenue Cycle Management, Practice Management Consulting, Compliance and Education. Kim has extensive experience in Anesthesia and Pain Management across all areas of expertise.
Kim Dues CPC CRC ICD-10 CM AAPC
Regional Director, RCM, Quality & Client Service
BillingParadise 24X7, Inc. BillingParadise.com
Kim understands the complexity of coding and reimbursement issues specific to your practice – both from the clinic’s perspective and from the payer side. She not only recognizes the compliance and accuracy necessity of correct coding but also understands what it takes to get paid. She is adept at improving the revenue cycle and can assist in determining what needs reengineering to enhance the reimbursement process. Kim has worked with a variety of private practices large and small.
She has presented topics on RCM, Practice Management, Anesthesia Coding with Decision Health and Risk Management with Rise Risk Adjustment Academy to its attendees.
Born a New Englander, resides in Texas with her husband and three children.
Areas of Expertise:
- Risk Adjustment / HCC
- Remote Coding
- Medical Documentation
- Remote Billing & Auditing
- On-Site & Webinar Training
- Best Practices
- Strategic Planning
- Change Management
- Process Design & Optimization
- Program & Project Management
- Recruitment, Growth, & Retention
- Vision & Action Planning
- Client & Employee Satisfaction
- Task- and People-Orientation
- Team Engagement
- Business & Workforce Development
- Public Speaking
- Microsoft Excel, Word, PowerPoint
Court Reporting Program
- Alvin Community College
- Alvin, TX
Special Education Pre-K & K
- Keene State College, Keene, NH
Clinical Documentation Improvement
- AAPC (Expected 2018)
- CPC / CRC / ICD-10-CM
- AAPC Member – 2005 #00088382
- AHDI Member – 2010
- 01-01 Life/Accident/Health
- 04-00 Variable Contract Agents
- 00-63 Uniform Securities Agent
- 06-00 Property Casualty
- 16-00 HMO
Administration | Litigation| Appeals | Billing | Coding | HIPAA
Wolfe Creek Holdings dba Mass Medical Billing Services
- Revenue Cycle Management | Coding Consultant – Dickinson, TX: 2002 - Present
- Forensis Group Subcontractor (Experts on Experts): 2017
- Independent Insurance Representative – Houston, TX: 1990 – 2002
Highly versatile Medical Bill Coder and Subject Matter Expert, offering organizational and communication skills, combined with unmatched knowledge in all aspects of medical coding, auditing, HCC/Risk Adjustment. Excel at directing and coordinating cross-functional teams to achieve sound business results. Seamlessly establish and maintain relationships with all stakeholders; able to work on multiple tasks to achieve quality monthly, quarterly, and annual outcomes. Quickly identify areas for improvement, develop and deliver online training via PowerPoint or onsite for staff and providers. Manage On Shore/Global teams firmly and respectfully to attain directives and benchmarks without supervision.
Work independently either remotely from a fully appointed office or on location to supervise staff and/or manage services. Save money via analysis and correct coding – CCI Edits and claims submission for payment based upon proper documentation, prior authorization, and insurance verification. Improve productivity and efficiency leveraging 16+ years’ experience in RCM. Adept at working in fast-paced and high-stress situations and comfortable presenting difficult information clearly and concisely.
- SME: Anesthesia, Pain Management
- Document Education: ICD-10-CM, MIPS, MACRA, E/M, DME, Part B Out-Patient
- Accounts / Audit: Revenue Cycle Management, Accounts Receivable, RADV, ZPIC, Commercial/Government Payer
- Anesthesia Management/CRNA group for seven years.
- Assisted medical provider in a complete overhaul of Pain Management clinic - within three years company was positioned for successful sale.
- Oversee accounts receivable, including posting payments via manual post/ERA, balancing with client’s CPA @ month-end along with provider payroll duties; full management including analytics and remote staff direction.
- CMS, Medicaid, Workers Comp, and Private Payer guidelines for the analyses and auditing of claims for billing and coding accuracy.
- EMR Template consulting along with documentation improvement integrity practice programs.EcW,Athena,HealthPac,Medisoft,AdvancedMD,Pr.Fusion,NueMD,Sevocity,EMD’s,etc
- MIPS/MACRA formerly PQRS reviews along with CMS year-end report reviews.
- Contract reviews - Explanation of Benefits (EOB), fee schedules, coding, modifiers, RVU, MUE, ASA units, ASA time units, RVRBS, LMRP, CCI Edits.
- Appeals and Corrected Claims - gather supporting documents and medical records for claims appeals; assess and interpret medical records for resubmission.
- Deliver consistent support and training to staff and global teams, including problem-solving as it relates to Revenue Cycle Management because of coding and modifiers.
- National Speaker at Rise Health Risk Adjustment, Coding-Con FLA, Revenue Cycle Management, and ACO-VBP.
- Performance trained: Risk Adjustment, HCC, MIPS-MACRA, Correct Coding Initiatives, HEDIS:
- 6+ years of experience managing Global RCM/Coding Departmental Teams
- 2 years Medical Summation/review
- 1+ year of HCC coding
- 10+ years consecutive Anesthesia Coding
- 7+ years Pain Management Coding
- 3+ years remote coding of Neurology, OBGYN, Laboratory, Ambulance, Gen. Surgery, Chiropractic, IDTF, Physical/Occupational/Speech Therapy, Radiology, Family, Gastroenterology, Internal Medicine, and Urgent Care