Dawn Carter-DuBose

Cincinnati, OH *****

ad4yzo@r.postjobfree.com

+1-513-***-****

Authorized to work in the US for any employer

Work Experience

Case Manager

Greater Cincinnati Behavioral Health Services - Cincinnati, OH November 2023 to Present

• Assisting homeless clients with mental health disabilities find housing A/R Follow Up Specialist

Cincinnati eye institute - Cincinnati, OH

May 2022 to Present

Research, process, appeal denied claims for Medicare, Medicaid, worker’s compensation, skilled nursing facilities, Anthem, Humana, All government not just including correction facilities, VA, Tricare for life, VACCN for all markets in Cincinnati and Virginia Markets. Safety Companion

Mercy Health Fairfield - Fairfield, OH

December 2017 to Present

Sitting with patients whom are suicidal or homicidal to ensure their safety. Claims Processor

Kelly Services, BC Forward-Anthem - Cincinnati, OH January 2021 to April 2022

• Researched denial codes and processed new day claims to make sure claims were entered correctly for payment.

• Researched reconsideration claims and Processed claims in Nextgen. Care Coordination Specialist

Council On Aging - Cincinnati, OH

September 2018 to January 2021

• Team educator

• Trained over 3 new hires

• Taking over 50 calls per day to assist with transportation request.

• Processing suspended clams

• Processing HME, DME, HOME MODIFICATIONS

• Emailing, Faxing, and making calls to providers and clients to follow up on services

• Sending out Referrals for personal care services, transportation, home delivered meals, emergency response systems, transportation, Adult day services, chore services

• Working closely with care managers to assure clients needs are being met Pharmacy Technician-Technician in Training

Humana Pharmacy

December 2017 to May 2018

• Clarifying prescription orders for patients with Dr. offices

• Sending, receiving, and cancelling faxes to and from Dr. offices.

• Making outbound calls to Doctor's office regarding the need of New prescriptions request for patients

• Making outbound calls to patients regarding their prescription refills.

• Working orders out of a CRM queue that patients send to Humana.

• Calling out on 65 plus request per day.

Claim Audit Specialist, HIM

Mercy Health Partners

2015 to 2017

• Entered in Request and Claim information for Auditing with Commercial and Defense Audit.

• Researched information in PA systems Artiva, Data Ark, AS400, to complete a request.

• Entered Audit dates for defense audit and high dollar charge audits.

• Prepared the invoices and itemized statements that have to be sent for the high dollar charge audits.

• Worked closely with the Director.

• Scanned in and prepared high dollar charts for Nurses to audit.

• Entered in 50 or more accounts for Commercial Audits.

• Researched and double checked all work is correct in MAC and RAC. State Tested Nurse Assistant

Bright Star

January 2014 to November 2015

• Assist clients with daily living

• Transport patients to and from Doctor appointments or personal errands. Front Office Specialist

Mercy Health Partners

2014 to 2015

• Scheduling and registering at least 60 appointments with patients face to face and on the phone daily.

• Collecting copays in the forms of cash, check, and credit card utilizing Rev-springs online payments.

• Pull, file, and prepare patients charts daily.

• Answering up to 3 telephone lines daily.

• Clerical Duties such as mailing, faxing, printing, copying, making folders for patients.

• Scanning in patient's insurance card, photo Id's, medical records.

• Making bank deposits for end of the day deposits.

• Accessing Availity and Epic to confirm patient's insurance eligibility.

• Contacting Insurance companies to confirm patient's benefits for therapy.

• Peer interviewed possible candidates for various positions. Advanced Scheduler

Mercy Health Partners

August 2010 to October 2014

• Scheduling and pre-registering appointments with patients and provider offices.

• Researching ICD-9 and diagnosis codes for medical necessity.

• Verify insurance, and authorizations.

• Interaction with Hospital departments and personnel, including Cardiology, Vascular, Special Procedures/Cath Lab, and Radiology

Unit Secretary

Mercy Health Partners

2012 to 2014

• Scheduled walkin appointments for radiology such as Xray's Labs.

• Filed, faxed, made copies.

• Answered multiple telephone lines.

• Printed out Films/medical records for patients and providers for different radiology procedures. Education

Certificate in State Tested Nursing Assistant

Cincinnati State Community and Technical College - Cincinnati, OH February 2012 to April 2012

Associate of Arts degree

Cincinnati State Community and Technical College - Cincinnati, OH November 2006

Skills

• Data Entry (10+ years)

• Pharmacy (10+ years)

• Scheduling (10+ years)

• Training (10+ years)

• English (10+ years)

• Customer Service (10+ years)

• Clerical Experience (10+ years)

• Medical Terminology (10+ years)

• Medical Office Experience (10+ years)

• Insurance Verification (10+ years)

• ICD-9

• Managed Care

• Microsoft Excel (10+ years)

• Microsoft Word (10+ years)

• Typing (10+ years)

• 10 Key Data Entry (10+ years)

• Epic (10+ years)

• CPT Coding (10+ years)

• EMR Systems (10+ years)

• AS400 (10+ years)

• Time management

• Administrative experience

• Microsoft Powerpoint

• Data collection

• Microsoft Office

• 10 key calculator

• Office experience

• Anatomy knowledge

• HIPAA

• Medical billing

• ICD-10

• Microsoft Outlook

• Medical Records

• Auditing

• Medical Scheduling

• Phone Etiquette

• Hospital Experience

• Multi-line phone systems

• Document management systems

• Communication skills

• Documentation review

• Customer service

• Clerical experience

• Typing

• Medical records

• Workers' compensation law

• Medical terminology

• ICD-9

• ICD-10

• Cash handling

• Epic

• HIPAA

• EMR systems

• Analysis skills

• Cold calling

• Hospital experience

• Training & development

• Documentation review

• Financial auditing

• Anatomy knowledge

• Cash register

• Research

• Microsoft Excel

• Data entry

• Organizational skills

• Communication skills

• Customer support

• Writing skills

• Microsoft Office

• Laboratory experience

• Payroll

• Pricing

• Computer skills

• English

• Microsoft Word

• Medicare

• HCPCS

• CPT coding

• Contracts

• Medical office experience

• Data collection

• Time management

• Negotiation

• Fair Housing regulations

• Case management

• Motivational interviewing

• Section 8

• Microsoft Powerpoint

• Phone etiquette

• Mobile applications

• Medical billing

• Medical transportation experience

• Data analysis skills

• Search engines

• EHR systems

• Google Suite

• Accounts receivable

• Revenue cycle management

• Microsoft Outlook

• Microsoft Access

Certifications and Licenses

State Tested Nursing Assistant

CNA

CPR Certification

Driver's License

January 2023 to January 2025

Additional Information

SKILLS SUMMARY

Data Entry/Alpha Numeric Keystrokes per hour over 10,000 Strong skills in MS Word, MS Excel, and MS PowerPoint, Data Entry, alpha-numeric and 10 key, MS Outlook, Last Word, EMR, AWD, Lotus Notes, AS400, MCO( Managed Care Optimizer), APM ProHelpdesk(Web Interface), HBO(Pre-registering and Financial research), PHS (scheduling), Rev Runner, EPIC, Availity, PAC's Scanner, Rev-Springs, Artiva, Data Ark, Comply Track, Pharmacy Technician in Training registered with Ohio State Board of Pharmacy.

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