Carla Beckford

** ******* ******* ********* *., Lehigh Acres, FL 33936 312-***-**** ac506l@r.postjobfree.com

Objective

To further my career in the health insurance industry using my related experience, knowledge, thinking skills, and training to the best of my capability. I strive to continue contributing to the development and evolution of healthcare quality program methodology and related activities.

Education

Evanston Township High School, Evanston, IL 1976 – 1980

Diploma General Education

Heritage Institute, Fort Myers, FL 2007 - 2009

Occupational Associates of Science/ Medical Assistant/ X-Ray Technician

Skills & Abilities

Educated as Medical Assistance with extensive knowledge in the medical field both hands on with patients and administrative duties. SharePoint Certified, Six Sigma (Beginner) Typing 70 W.P.M on a PC w/10 key touch experience. Proficient in, PeopleSoft (Time & Labor) Proficient in claims analyzing/adjudication. Coordinating and educated my peers on of provider contracts and billing practices with the ability to analyze financial and numerical data. Working knowledge of all Microsoft Office programs. Extensive knowledge in insurance products in tandem with experience with provider payment programs and billing practices. Experience with insurance products and network configurations with commercial insurances including Medicare and Medicaid. In-depth knowledge of ICD-9, ICD-10 and CPT/HCPC coding, as I was in charge of billing claims, posting payments, and disputing non-payment(s) and benefit interpretation

QUALIFICATIONS

Microsoft Office Certified, Windows XP, Windows 7 & 8. Extensive knowledge of Groupwise, Epic, ON Base, Pega, Visio, Visual One, On Q, Intergy, Citrix and Owan

Beginning user knowledge within the Diamond/XCELYS in other Wellcare related programs.

Extensive Prior Medical Field Experience in many different aspects as indicated below in my work experience and education

Currently assisting Wellcare members and providers navigate the Wellcare website while providing technical support and research

10 years of health insurance experience

3 + years of project management experience

Exceptional time management, planning, and organizational skills

Demonstrated ability to troubleshoot and problem solve independently

Outstanding diplomatic interpersonal and communication skills (written and verbal)

Cultivated long-term professional relationships with numerous healthcare providers and internal customers/partners

Experience

AUTHORIZATION SPECIALIST 21ST CENTURY ONCOLOGY, FORT MYERS, FL 1/29/2018 - PRESENT

Support for multiple physicians

Ensured patients receive medication that requires pre-authorization from insurance carriers

Gathered insurance information from patients to determine if authorization is needed for service

BEHAVIORAL HEALTH INTAKE COORDINATOR WELLCARE HEALTH PLANS, TAMPA, FL 12/15/2014 – 8/31/2017

Assist providers and other medical personnel with information regarding behavioral authorizations in multi-States

Execute medical and behavioral authorizations via various transmission methodologies within the intake department and transfer the documentation to the Clinicians’ department

Participate in a multitude of projects which benefit WellCare’s clients within the assigned areas of operation

CUSTOMER SERVICE REPRESENTATIVE/ WEBSITE TECHNICAL SUPPORT WELLCARE HEALTH PLANS, TAMPA, FL 9/9/2014 – 12/14/2014

Providing website support for our members and providers while cultivating a positive experience with our members and providers

Assisting with various issues including but not limited to password/user name support

Consistently and successfully navigating our members and providers throughout the many systems and documentation available to them on the Wellcare website(s), depending on the type of inquiry and line of business in question

Submitting problem tickets if there is any type of issue with any aspects of the website(s) and troubleshooting any “behind the scenes” issues with user name(s) and/or passwords

Provide daily reports to my superiors on any escalated or issues that associates cannot resolve. Once resolved I provide follow up phone calls to advise of the situation or status of their issue

ADMINISTRATIVE/ CALL CENTER REPRESENTATIVE ENTERPRISE HOLDINGS, FORT MYERS, FL (TRANSFER TO TAMPA, FL 2014) 2011 – 9/2014

Providing outstanding customer service to internal & external partners

Explaining and confirming people’s booking reservations and follow up procedures as necessary

Generating daily reports for management utilizing Microsoft Excel

Receiving and placing calls to ensure quality assurance to our clients

Completing data entry of all attributes of an inquiry received

CLINICAL ASSISTANT PROVEN MEDICAL TEAM, ARLINGTON HEIGHTS, IL 2010 - 2011

Provided medical assistant duties and front desk support for patients

Confirming members eligibility and benefits utilizing Availity, provider portal and calling various insurance companies for authorizations, benefits, and claim disputes

Using my caring personality to help members through the steps and procedures of their appointments and what to expect if they should be having a procedure etc.,

Coordinating admissions into facilities and assisted the MD or RN with discharge planning

Provide numerous clinical assisting procedures for the RN/MD i.e. cast removals, preparation for injections, fitting walking boots, splints, etc

MEDICAL ASSISTANT BERND RAPHAEL, MD PA, LEHIGH ACRES, FL 2008 - 2009

Performed all front office procedures, including accounts payable and accounts receivable

Billed claims to various insurance companies including Medicaid & Medicare, and reconciled remittance advices to ensure payment

Contacted providers and members to schedule appointments, obtain authorizations, confirm benefits and coordinate care on behalf of the RN/MD

Filed appeals for member/employer to try and have appeals overturned for claims payment

Supervised a staff of 5 coders, to ensure accuracy on claims and appeals

Other duties include but not limited to: completing patient vitals, administration of injections, and performing medical tests (EKG, ABI, ANS, Urinalysis)

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