Beverly R Carlson

*** ******* **. **** ******, IL 60466

708-***-**** (home) or 708-***-**** (cell)

ac7uab@r.postjobfree.com

Objective

To apply my strong knowledge of medical insurance follow-up (including denials and appeals) in either an office or hospital setting. I am interested in continuing to develop my skills and grow with the organization.

Qualifications

-- Over 18 years’ experience in medical insurance follow-up (denials, appeals, collections) for both hospitals and physicians

-- Excellent understanding of insurance contracts verbiage

-- Very strong customer service background

-- Creative problem solver

-- Successful record in sales, marketing and management.

Computer Skills

Strong computer skills / quick learner. Proficient in: IDX Citrix, Nebo, ECare, Meditech, NECS, Allegra, Facs, NSure, LexisNexis, Navinet, Emdeon and HPF. Also proficient in: PMT, five9,IEX and EDS. Also Microsoft Excel and Word (some PowerPoint).Very strong in EPIC billing queues and follow up queues, Centricity,Availity, Salesforce, UHC Link,OneSource and NGS/Connex.

RELEVANT EXPERIENCE

AR Specialist II 09/17/18 to 11/2/18 Position Termed

Conifer Health Solutions – 8151 W 183rd St,Tinley Park, IL

Followed-up and resolved outstanding managed care medical claims.

Submitted appeals, followed-up on appeals submitted

Documented and coded accounts per client specifications

Health Plan Advisor 04/17/17 – 05/14/18

Go Health – 225 W Superior Chicago, IL 60654 Position Termed

Explained Health Insurance to Medicare Beneficiaries

Completed enrollment if benefits fit beneficiaries needs

Updated clients systems on all calls

Health Plan Advisor 09/08/14 – 01/31/15 (temp during open enrollment) and 10/13/15-01/31/16 (temp position during open enrollment) Also from August 22,2016 to Feb 15,2017.

Go Health – 222 Merchandise Mart Plaza, Chicago, Il 06054 866/506/1260

Explained health insurance benefits to customers according to The Affordable Care Act.

Noted sales systems per client specifications. Used new system Salesforce for 2016-2017

Claims Collector 02/02/16-04/04/16 (Temp position)

Ingalls Memorial Hospital,Harvey,Il 60426

Follow-up on open medical claims for a resolution.

Contacted payers such as Medicaid and commercial insurance companies to determine the reason for denial and made corrections, resubmitted claim.

Followed-up on a lot of HMO/Commercial/Work Comp/Managed Care open balance accounts.

Verified eligibility on websites - BC/BS, Aetna, United Healthcare, Medicare, Medicaid, Availty.com, others.

Claims Collector 02/16/15 – 08/28/15 (Temp position)

Franciscan Alliance (through Aerotech ) – Schererville, IN

Follow-up on open medical claims for a resolution.

Contacted payers such as Medicaid and commercial insurance companies to determine the reason for denial and made corrections, resubmitted claim.

Submitted paper & electronic appeals to Indiana Medicaid, United Healthcare & VA

Biller/Collector 1997-02/28/14 (dept. closed due to downsizing)

MAC/TCS, Med Source, NCO Financial, EGS - Matteson, IL

Followed-up and resolved outstanding managed care medical claims.

Submitted 30 or more appeals per day, followed-up on appeals submitted.

Analyzed accounts for bad debt.

Collected on high dollar accounts.

Documented and coded accounts per client specifications.

Participated in training new employees.

Supported and addressed customer service issues.

Took and passed FDCPA for collections.

Ensured claims paid per rate contracted with client, if not called and sent appeal.

Followed-up on a lot of HMO/Commercial/Work Comp/Managed Care open balance accounts from AR report.

Verified eligibility on websites - BC/BS, Aetna, United Healthcare, Medicare, Medicaid, Availty.com, others.

Patient Care Specialist – Special Projects – Onsite Representative 1998-2001

University of Chicago Hospitals – Chicago, IL

Performed all admission and pre-admission verification, pre-certification and financial evaluation for in-patient hospitalization.

Verified all scheduling for both inpatient and outpatient services

Documented all information per client specifications to submit for billing

Performed thorough analysis of patient financial data

Determined and met requirements of third party payers to secure reimbursement for most all patient services

Submitted appeals/denial letters when denial was posted on accounts.

Established payment arrangements with patients when needed

Contact hospital finance department for patient cost (self- pay patients)

Verified all insurances upon admission via website or phone

Worked accounts from AR report.

Collector/Biller, Special Projects (Onsite Representative) 2001-2002

Ancilla Health Systems – Hobart, IN

Participated in the set-up of a billing and collections office

Verified, coded and billed open A/R balances on medical claims

Submitted appeal/denial letter when denial was posted.

Followed up on appeals/denials that were sent for payment.

Documented accounts per client specifications

Verified and billed Indiana Medicaid on NECS system

Set up payment arrangements per client specifications

Supported and addressed customer service issues promptly

Analyzed accounts for bad debt

EDUCATION

High School Diploma

ICD-9 Coding Certificate

Business Courses: Business for Entrepreneurs, Business Law 1, Business Sales

Insurance Licenses (current for Illinois, Michigan, Virginia, New Mexico and Texas)

Contact this candidate