1. Kym Wilson
Forney, TX 75126
214-554-1243
kymwilson23@outlook.com
BACKGROUND SUMMARY
Goal-oriented with strong work ethic and analytical skills. Experienced Manager and Medical Biller/Collector with
thorough knowledge of hospital operations; and managed healthcare practices to include employee recruiting and drug
test administration. Compliance, Healthcare Medicare/Medicaid RAC auditing investigation. Experienced
implementation of client deliverables and recommendation of new policies and procedures. Strong problem solver;
highly competent in resolving issues and conflicts Management of clinical claims appeals and tracking of trends to
proper resolution. Project Management Recruiting, interviewed/investigation of new hires. Performed training for new
hires and overseeing their production. Highly productive; proficient in completing detailed reports and projects.
Hospital inventory management. Proficiency with PC working within the following applications, ACE, PBAR,
IMACS, CITS, OSRx, X-CLAIMS, MDX systems, MS Word, Excel, Internet, SharePoint, e-mail, and Microsoft Visio
and PowerPoint presentation.
EMPLOYMENT EXPERIENCE
Recovery Audit Coordinator (RAC) UT Southwestern (100/2013-10/2014)
Responsible for the ongoing and proactive coordination of the RAC appeals processes. I communicated directly with
involved departments, to include: Nurse Audit investigation, Coding specialist, Compliance and Revenue Integrity. I
was responsible for the management of timely, synchronized response to RAC audit requests and created reports that
accurately track all RAC requests, correspondence, actions and outcomes to case closure. Responsible for the
development of workflow documents and education of the RAC process to assure proper tracking.
Recovery Audit Coordinator (RAC), HMS Health, Irving TX (2012-2012) Contract
Provided operational support to the SBU for RAC implementation documents, agendas, workflows . Recovery Audit
documentation including regulatory and accreditation. Facilitated internal meetings to achieve implementation tasks and
timelines. Developed Vision workflow documents for State RAC process. Developed MS Project Plans for RAC
implementations and RAC chart auditing. Updated Implementation Tool Kit documents as necessary. Provided project
support to RAC Implementation Managers with system development and implementation. Worked closely with the
reimbursement managers to increase revenue collections.
Recovery Audit Contractor Clinical Appeals Manager, LifeCare Hospitals, Plano TX (2009-2012)
Supervised case management team to assure submission of documents request by CMS. Developed process for
uploading all patient record requests and subsequent clinical claims appeals for all RAC, MAC, MIC, CERT’s, QIO and
ZPIC’s chart auditing. Worked with Accounts Receivables Manager and Coding Managers during RAC auditing
investigations. Organized work-flow system for clinical appeals resolution according to the requirements of the state
and federal regulations. Collected on all appealed claims to assure proper resolution.
Accounts Receivable Supervisor, MedAssets Plano, TX (2006-2009) Contract
Provided direct, daily supervision to collection team conducted interview and background checks during hiring of new
employees. Responsible for assuring proper collection efforts of delinquent accounts receivables to gain final
resolution and chart audit investigation.. Responsible for overseeing the preparation of monthly billings, daily posting
of payments, the collection of overdue accounts in the accounts receivable module, and the facility mail system as it
relates to cash receipts
Compliance Manager, US Bio/AmerisourceBergen, Addison, TX. (2007-2009)
Reported, forecasted, trend analysis, quality assurance, recommend and implemented resolution for home infusion
billing issues and appeals after chart audit investigation. Tracked changes in regulatory and accreditation
requirements and assisted in formulating and distributing policies and procedures within local, state, and federal
regulations. Processed accreditation and licensure applications for all facility locations.. Investigation of unusual
occurrences and incidents to assure proper follow up and resolution. Tracked all pharmacy inventory management
Conducted employee background investigations for all facilities. Performed internal audits at the Corporate Office and
traveled to other branch locations to determine compliance according to JCAHO and OSHA regulations.
Charge Master Analyst, HCA Financial, Irving, TX. (2006-2007)
Monitored Charge Description Master (CDM) data base to maintain compliance with corporate standards, federal and
state guidelines regulations. Maintained the CDM to improve the workflow process & maintenance of the charge
master database and performed chart audits. Monitored regulatory and accreditation after careful investigation of
regulatory guidelines. Performed criminal backgrounds on all pharmacy personnel. Tracked hospital supply chain
inventory management.

2. Appeals Analyst/Dispute Resolutions Manager, Tenet HealthCare Corporation, Frisco, TX . (2003-2006)
Increased collections, maintain policy & procedures, and stay within FDCPA guidelines. Negotiated with insurance
companies to reconcile on payment offers to settle accounts and chart auditing. Composed appeal letters to be
submitted to insurance. Received inbound calls from Tenet employees, patients and outside vendors seeking advice
and consultation about policies and ethical issues they may encounter. Conducted investigations of issues to closure.
Coordinated with Human Resources, Quality Management, Risk Management, Compliance and Audit Services during
investigation and monitoring all policies and procedures where applicable to resolve employee, patient and vendor
issues accordingly.
Biller/Collections Team Lead, Coram Health. Dallas, TX (1998-2003)
Provided leadership and support to billing and collection team and trained new hires the basic knowledge of skip
tracing collections investigation.. Interfaced extensively with patients, insurance companies, and physician's offices to
ensure account reconciliation chart auditing. Provided patient financial and disability counseling.
Education
University of Phoenix
Bachelor of Science- Business Management