Karen Swain

**** * ***** **.

Raleigh, NC *****

919-***-****

ac79fn@r.postjobfree.com

PROFESSIONAL SUMMARY

Administrative and technical customer support professional with excellent communication skills; comfortable working in fast-paced environments demanding strong organizational and interpersonal skills. Seeking a position conducive to growth and further development of my business skills.

PROFESSIONAL EXPERIENCE

Health Management Systems (Raleigh, NC) 02/2006 – 08/2017

Subrogation Case Worker I

Evaluated Medicaid Recoveries

Effectively work, maintain and manage a variety of cases with current and accurate notes from

creation to recovery

Interpreted diagnosis codes, EOB codes, Provider Specialty Codes

Verified income, county codes, all Recipient information

Cash receipts, Identify provider refunds, Refund Inquiries

Data Entry-Keying new cases into HER systems

Confirm and validate third party liability and probate and beneficiary asset research

Inbound/Outbound phone calls, multi-lines

Negotiate and compromise claim/lien settlement amounts per contract guidelines

Conduct ongoing periodic follow up on case status and payment

Confirm documentation of eligibility for beneficiaries

Interfaced with attorneys, insurance adjusters and medical providers

Stock Builders Supply (Raleigh, NC) 2/2005- 11/2005

United Healthcare (Cary, NC)

Siemens (Wendell, NC)

Data Entry/Billing

• Entered Invoices in a timely manner

• Scanned Invoices in system to be retrieved by data entry levels

• Assisted billers with processing denials/appeals

• Ran reports, quality checked invoices against reports

• Researched discrepancies on invoices involving discounts

Public Consulting Group (Westaff, Inc.)(Raleigh, NC) 08-2004 –02/2005

Accounts Receivable Representative

NC Medicaid System/MMIS – Verifying Eligibility, Cash Receipts, Provider information, viewing paid/denied claims/Recipient information

Supervised over 8 people

Time clock updates/Timesheets for over 20 people

Data entry

Research and follow-up of denials

Posted, worked and keyed denials

Maintained several Excel spreadsheets

Explanation of Benefits

EDUCATION

Caldwell College Wake Technical College

1979 – 1983 Medical Coding I – 05/2004

SKILLS

10-key touch HCPCS

Microsoft Word MMIS

PowerPoint NC Tracks

Access Keyboarding 55 wpm

Excel ICD-10 Coding

Data Entry ICD-9 Coding

REFERENCES AVAILABLE UPON REQUEST

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