Carla Lewis

**** ******* ***** ****** *******, GA 30127 813-***-**** (cell) acd9sv@r.postjobfree.com

Professional Profile

An accomplished and motivated professional with more than 20 years of proficient experience in the

medical field, holding various positions in medical billing, collection, claims adjudication insurance

verification, patient registration and payment posting.

Core competencies include:

• Thorough understanding of medical terminology

• Knowledge of state and federal regulation policies and procedures to ensure compliance

• Strong analytical and problem solving skills

• Excellent customer service skills

Professional Experience

Surgery Partners, Tampa, FL

2008 – June 2013

Patient Account Representative

• Assisted with all functions associated with outstanding account balances from third party payers

• Proactively identified collection trends and solved them in a timely manner

• Performed collections actions to include contacting patients and resubmitted claims to the

appropriate payer.

• Evaluated patient financial status and established payment plans as appropriate

• Effectively worked A/R reports and met assigned cash and productivity goals.

Express Dental Care, Tampa, FL

2007-2008

Dental Coordinator

• Answered and directed incoming calls to the appropriate person or department from insurance

companies, dental providers, employers and patients

• Obtained notes and plans of treatment from dental offices; reviewed documents for

compensability

• Obtained authorizations from Workers Compensation insurance companies for necessary

treatment

• Scheduled appointments for authorized treatments

Randstad Staffing Services, Tampa, FL

2005-2007

Credentialing Specialist

• Validated physician licensing

• Conducted extensive background research regarding ethical practices

• Quality assured provider profiles to ensure medical claims were properly billed

United Healthcare Claims, Oldsmar, FL

2005 – 2005 (temporary, 3 months)

Claims Representative

• Analyzed and moved claims towards resolution using best practices

• Documented files to include all key activities, contacts made, statements taken, including a full

outline covering all aspects of the claim and requirements for resolution and processed claims

with Esurance claims systems

• Investigated and handled first and third party claims involving coverage and liability

determination

NCI Insurance, Kennesaw, GA

2003-2004

Manage Care Representative

• Answered incoming calls from customers concerning account information

• Placed outgoing calls to follow up on billing and collections

• Handled concerns with claims from multiple insurance companies

• Resolved problems resulting from claim settlement

• Performed audit of randomly selected claims to ensure quality processing

• Researched claim overpayments

Blue Cross and Blue Shield, Atlanta, GA

1999-2002

Claims Processor III

• Processed medical claims for payment

• Coordinated benefits based on members plans and insurance policies

• Answered incoming call from clients and patients

• Researched benefits to obtain necessary documentation to process customers’ claims

• Entered claims data into office proprietary system

• Followed adjudication policies and procedures to ensure proper payment of claims

EDUCATION

Medical Assistant, Bryman Campus, Atlanta, GA

Registered Nurse, University of Louisville, Louisville, KY

SPECIAL SKILLS AND ABILITIES

• Excellent communication skills

• Outstanding telephone etiquette

• Effective interpersonal skills to handle several inquiries in a diplomatic manner

• Excellent data entry skills

• Proficient in MS Word, Excel, Email and Internet

• Ability to provide professional customer service in chaotic situations

CERTIFICATION

Cardio Pulmonary Resuscitation (CPR)

REFERENCES

Available on request

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