CARRIE TERAN

*** *********** ***

El Paso, TX ***02

915-***-**** (H)

915-***-**** (C)

QUALIFICATION SUMMARY

• Over 21 years in the medical billing and collection field

• Five years experience as medical insurance claims analyst

• Referrals, hospital inpatient and outpatient surgical pre-certification

• Extensive knowledge of CPT and ICD-9 coding, medical terminology, pharmacology reimbursement issues for all insurance types, including HMO, PPO and worker’s compensation.

• Direct contact with insurance representatives and patients resulting in the resolution of many aging reports. Thousands of dollars recovered as a result of assertive and diligent efforts.

• Excellent communication skills and ability to train and teach.

• Proficient at auditing patient medical records and accounts from admission to discharge

EXPERIENCE

July 2007 to January 2008 Business Office Consultant

THE PHYSICIANS CENTRE HOSPITAL-BRYAN, TX

Temporary consulting position. I was recommended for this position by the CFO at El Paso Specialty Hospital. I improved the processes in all areas of the business office, from the front desk , to the billing and collection department and acted as liaison between medical records and coding

.

May 2000 to March 2007 Claims/Payment adjudicator/Business Office Team Leader

EL PASO SPECIALTY HOSPITAL-EL PASO,TX

Responsible for adjudication of all payments, according to contract terms and/or agreements. Identify underpayments and direct appeals process for prompt recovery. Responsible for quarterly audits of patient accounts, for best practice and total account management. Identify areas in need of performance improvement and provide additional training when necessary. Accountable for end of month processes including resolution of credit balance, aging and other accounts receivable reports.

Dec 1999 to March 2000 Business Office Manager

HEALTHSOUTH MEDICAL CLINIC-EL PASO,TX

Managed front desk and billing/collections departments. Quality control of Workman’s Compensation, HMO and PPO claims submissions. Responsible for maintaining protocols set by employers, which specified preferences in the handling of their employees as patients. Participated in weekly administrative meetings, to troubleshoot and resolve issues, involving my departments. Responsible for the balancing and reporting of all A/R monthly reports.

Sept 1998 to July 1999 Claims processor and Team Leader

ASSURED BENEFITS ADMINISTRATORS-EL PASO,TX

Processed medical claims for Third Party Administrator which

Included several companies with various benefit plan options.

Team Leader responsibilities included monitoring customer

service representatives, assisting with problematic phone calls,

addressing appeals, individual claims management and training

new employees.

Sept 1997 – Dec 1997 Referral Specialist

COLUMBINE FAMILY PRACTICE – LOVELAND, CO

Responsible for referrals and pre-certifications Coordinated patient care

Between PCP’s and specialists by making sure all documentation was

Conclusive.

June, 1995 to July, 1997 Collection Manager

FIRST PROFESSIONAL SERVICES – LOVELAND, CO

Solely managed collections for 6 physician groups consisting of 4 – 14

MD’s per group. Composed and instituted a collection letter in Spanish

Which increased communication and resulted in higher remittance from

Spanish speaking patients. Devised a verbal method of pulling in at

Least partial fee for services rendered to patients who otherwise

Qualified for 100% discount.

EDUCATION G.E.D – 1979 FROM EL PASO COMMUNITY COLLEGE

CERTIFICATIONS IN HOSPITAL UNIT SECRETARY AND

HOSPITAL PHARMACY/IV TECH

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