CARMEN KICINSKI CARAKER

Orlando, Florida *****

www.Linkedin.com/Carmen L Kicinski Caraker

321-***-****/ac0huh@r.postjobfree.com

Results oriented Medical office Specialist who has worked in billing and collections, insurance claims and appeals, data entry and payment posting for many health specialties. My strong work ethics and high performance in accounts receivable and billing have given me 93 to 95% success rate in claim payments. I have a BA, a Health Insurance License and bilingual in Spanish. I am responsible, highly motivated and focused on doing my best on my assigned work. My goal is a full time position where I will produce heightened profits for your company. My areas of expertise include:

Billing and Collections Medical Terminology, ICD 9, 10, CPT

Data Entry and Payment Posting Health Insurance benefits, verification and referrals

Claims Appeal resolution Proficiency in Microsoft Word/ Excel/Outlook

PROFESSIONAL EXPERIENCE

OPTUM /KAISER PERMANENTE INSURANCE August 2016-February 2017

Sales Agent

Received calls from customers, with relevant dialogue on their health needs, using BConnected to record their personal info. Used Kpedia 2.0 and kp.org to discuss details of health plans to new prospects. Provided quotes based on customers demographics for 9 states in English and Spanish .Coordinated health plans sales by phone by explaining process to customers while using Sign Me Up tool for new business and recording payments. Answered inquiries about treatment estimates or medications included in plans using Kpedia 2.0

INFINITE COMPUTER SOLUTIONS

Prove It Billing and Collections Test Editor November 2014-January 2015

Work at home contract assignment with Prove it /Kenexa Tests. Six medical tests were revised that needed to be checked for errors. Research that test questions are updated with current standards on the following topics: collections, billing, records-ICD10, records coding CPT and billing forms UB-04 and 1500. Update outdated information by suggesting areas that need changing. Tests were revised for use of correct terminology. Work assignments sent by online e-mails with dates to complete work. Supervisor was Drew Hikes, Associate Product Manager. Contact at ac0huh@r.postjobfree.com. Phone: 215-***-****.

REMX STAFFING SERVICES

Insurance Batching Representative July 2013-September 2013

Temporary contract at Florida Hospital Central Billing Office. Organized mail, patient and insurance payments into groups or batches for payment posting. Tally up payments with the calculator. Mail and payment batches logged daily. Scanned mail and patients checks with Digiport. Located patient accounts, using Sunport, to send mail to other departments. Reviewed EFT batches-to ensure all batches have zero discrepancies, supporting batch number and remit documents. After first week of starting assignment, the two week backlog was corrected and made current. Payments from another department were added to daily tasks.

ACCURATE MEDICAL BILLING

Billing and Collections Specialist March2010-March 2011

Worked accounts for Medical Village Healthcare, posting charges, payments and collections for Medicaid and private insurance. Searched EFT reports for denial codes, corrected and resubmitted unpaid claims for reprocessing. Created appeal letter for denied claims. Client had many errors in coding patient’s vaccinations and claims had to be reviewed for missing modifiers. Saved $1,400 a day by editing charges; saved the client $30,800 per month. Printed Medicaid reports from website for posting payments and resubmit unpaid claims. Collection report was used to call on insurance to work on denied claims. Insurance websites were searched for claim payment and insurance verification.

EAST ORLANDO MEDICINE GROUP

Billing and Collections Specialist January 2009-January 2010

Billed office and hospital charges, posted payments and worked collections for Medicare/private insurances. Checked claims when specific procedures were posted so that it had the required information needed for the claim to be paid the first time they were submitted, saving time and money. On average, saved $2,523 a day, $55,506 a month on clients claims .Able to notice trends in denied claims. After investigating, found out that a large group of claims were sent to the wrong insurance address. Claims were resubmitted and paid. Reviewed EOB payment reports to call insurances on unpaid claims. Talked to insurance reps to find out the reasons for patients’ unpaid charges. Sent billing claims electronically.

ORLANDO HEART SPECIALIST

Office and Hospital Billing Specialist April 2000-November 2008

Posted office and hospital charges for group of doctors and assistants. Printed invoices and 1500 forms for billing. Balanced daily charges. Checked hospital charges to verify procedures, diagnosis and modifiers followed ICD 9 and CPT codes. After claims review, saved $6,599 per day, $145,178 per month. Trained coworkers to post charges. Obtained referrals. Advised patients on how to talk to insurance about unpaid claims. Verified insurance benefits for patients’ visits Posted insurance fee schedules. Helped post insurance payments for end of month report.

EDUCATION

Health Insurance Training for License at College of Insurance at Optum

Individual 1 year study for PCP test (2015) with online training on ICD10 /www.Codapedia.com

Microsoft Word 2010, Excel 2013 Certificates/Orange County Library (2014)

Internet course on Electronic Health Records Specialist, Allied Health Academy (2011-2013)

Bachelor of Arts/ University of Puerto Rico, Education English, 45 credits in Secretarial/ Accounting

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