Home Health Insurance
Resume:
CARLETA J. ANGLIN
Garner, NC 27529
*******@**.**.***
OBJECTIVE
A Position in Health Care or Business Industry utilizing my skills in
Problem Solving, Decision Making Communication and Leadership to provide
Increased Business Revenue.
SUMMARY
. Over 10 years experience in the Healthcare Industry which consist of
Medicare, Medicaid, Commercial, Home Health, Mental Health and Behavioral
Health
. Managed 15 employees in the Home Health and Behavioral Unit at Cigna
. Ability to communicate with patients and providers orally and in writing
. Knowledge of Medical Claims Auditing, Medical Insurance Billing, CMS-
1500, UB04 forms, Medical Terminology, CPT, Revenue, ICD-9 and HCPCS
codes
. Strong ability to gather data, compile information and prepare reports
. Exceptional ability to prioritize work to meet goals and deadlines within
acceptable time frames
. Hardworking, motivated, energetic, dedicated and professional individual
able to serve clients in a conscientious and pleasant manner
. Knowledge with various medical billing systems such as Famis, Unicare,
SMS, Sorian, Cirius, PMHS, AS 400, Chancellor, FISS, Affinity and FACS
. Proficient in Excel and Word
PROFESSIONAL EXPERIENCE
WAKEMED HOSPITAL RALEIGH, NC (2009-2010)
MEDICARE CLAIMS SPECIALIST
. Analyzed and adjusted complex Medicare accounts saving the Company
thousands of dollars each month
. Processed over 80 Medicare claims per day in areas of surgical,
physical therapy, speech therapy, occupational therapy, home health
and liability
. Researched and responded by telephone and in writing to patient
inquiries regarding billing issues and problems
. Communicated with Medicare and Patients for prompt payments
. Maintained a spreadsheet for delinquent accounts to be investigated,
adjusted, balanced and processed
STATE GOVERNMENT RALEIGH, NC (2006-2009)
PATIENT RELATIONS REPRESENTATIVE V
. Processed over 50 Mental Health and Substance abuse claims daily for
the Department of Health and Human Services
. Communicated with Insurance Carriers such as Cigna, BCBS, United
Healthcare and Medicare for prompt payment
. Managed complex patient accounts involving State and Federal funds
. Researched, investigated and adjusted over 10 Mental Health Insurance
Reports weekly exceeding $20,000.00
. Rejected claims for missing information such as patient demographic,
authorizations, insurance company, ICD-9, CPT, HCPCS and Revenue codes
WAKE COUNTY HUMAN SERVICES RALEIGH, NC (2005-2006)
ACCOUNTING TECHNICIAN SPECIALIST
. Maintained data on receipts, expenditures and provider billings
. Balanced provider accounts and researched delinquent data
. Tracked, recorded, analyzed and posted payments to provider accounts
. Managed a financial spreadsheet for over thirty providers
CIGNA HEALTH CARE RALEIGH, NC (1997-2005)
CLAIMS ANALYST/ APPEAL SPECIALIST
. Processed 90-100 Inpatient, Outpatient, Home Health and Behavior Health
claims daily and coordinated insurance benefits
. Audited and adjusted over 300 claims monthly exceeding $100,000.00
. Investigated fraudulent provider billing that resulted in saving the
Company over $20,000.00 a year
. Analyzed complex correspondence appeals, setup fee schedules, verified
authorizations for patients and calculated provider reimbursements
. Trained new employees on Home Health and Behavioral Health claims
INDUSTRIAL COMMISSION RALEIGH, NC (1996-1997)
DATA CONTROL SPECIALIST
. Processed Workers Compensation claims and researched coverage
. Updated Compromise Settlement Agreements and Self-Insurance
Closed out resolved Workers Compensation Cases on computer
. Provided coverage information to Attorneys, Claimants and Insurance
Carriers
EDUCATION
Business of Administration / Accounting, Fayetteville State University
References: Available upon request.
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