SHIMENA CARTER

***** ******** ***** #***

HOUSTON, TX 77060

(832)894-4172cell

405-***-**** message

acsl10@r.postjobfree.com

Work History

The National Radiology Network/Unique Staffing, Houston, Texas

Claims Resolution Specialist

January 2011-Present

-Monthly view of revenue cycle

-Biller/coder radiology services

- Billing claims to most major insurance companies

-Reconciliation of Daily claims

-Verifying insurance eligibility,

-Entering patient demographics

-Posting records to the billing system.

- In/outbound Calls to contracted facilities

-A/R

-Providing month end report of outstanding A/R to CFO

- Appealing denied claims

- Working Correspondence

-Claim adjusting/write-off projects/posting error projects/

-Invoicing Patients/Patient soft collections

-Credentialing verification of new providers/contracts

AAA, Oklahoma City, Oklahoma

Emergency Road Service Agent

06/07/10-10/08/10

-Inbound ERS Calls

- Locator

- Complete documented complaints

-Direct members to correct departments for additional memberships

- up sell product

Sleep Disorder Centers Inc, Oklahoma City, Oklahoma

Accounts Specialist

Jun 07, 2009 - Feb 02, 2010

-Bill claims to a wide range of insurance.

-Review accounts for outsource billing.

-Process request for write off accounts

- write off for outstanding accounts.

-Knowledgeable of correct CPT codes and billing rule for DME equipment and sleep medicine.

-Collect explanation of benefits from all insurance and give to posters.

-Track all payments on a spread to report each week and month.

-Communicate with each department to make sure payment received and posted.

United Healthcare, OKLAHOMA CITY, Oklahoma

Benefits Specialist

5/8/06-4/24/09

-Provide customer service at an inbound service center as a third party administrator.

-Assist Heath choice subscribers in reviewing their benefit plan. Explaining what benefits they have for Medical and Dental coverage.

-Assist health choice members in reviewing processed claims, explanation of benefits, payment information and when their claims have completed processing.

-Send contracted provider requested claim information, review claim processing details and calculate over and under payments from processed claims.

-Making sure the steps are taken to coordinate health choice members correctly with other insurance plans.

-Complete investigation of claims based on policy and plan provisions of Health choice guidelines.

- Review images of requested documents, and making sure they get to the right department for claims processing.

-Perform data entry of ICD-9 codes and current diagnosis codes.

-Responsible for accuracy in data entry and verifying entry work.

-have detailed knowledge of company operations, technical skills and solve routine problems.

-Assist providers with balance billing and correction of their ledgers.

-Auditing claims and paying based on contract.

Education

University of Central Oklahoma Undergraduate Bachelors of Science 2010

Oklahoma City Community College Associates of Art 2009

References

Lacrisha Johnson 6808 Woodlake Dr 73102

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