JACINTHA CARTER

**** ******** *** * ** LOUIS MO *3136

314-***-****

OBJECTIVE

TO OBTAIN A POSITION AND UTILIZE MY EXPERIENCE I Am a Military Veteran with Accounting skills I have several years of experience in Medical field since 1989 with skills in Eligibility plans Medicare DDE system and Medicare CSNAP for physicians. Familiar with Managed care Plans for Medicare Insurance

Claims Analyst,Medical Biller, Collection Rep, Customer Service Skills a plus and other Medical Office skills I am experienced with Excel capable of creating a spreadsheet and follow up MS Word a plus. I have experience with EDI system sending claims,verifying eligibility and follow up in EDI system. Worked on Epic, Amysys, AS400, Medicare DDE Part A and other systems within medical management systems. Capable on preparing Appeal letters if needed.

EXPERIENCE

PYRAMID STAFFING CENTENE

Claims Analyst 01/10/2022 -01/02/2023

Responsible to process medical claims on Medi-cal accounts clearing edits and completing adjudication. Determination of correct payment and insurance plans. Appealed any denied claims. Responsible to verify eligibility coverage. Reviewed Eligibility and corrected any errors. Prepared Microsoft letters to be submitted to patients. Worked excel spreadsheet for any old claims to be corrected. Experience with updating documentation and receiving emails fir follow up on claims processing.

Capstone Performance Peak Health

MEDICAL Claims Processor

08/2018-01/2018

Reviewed claims on a paperless system clearing edits and preparing for adjudication. Group claims And Medicare healthy benefits claims. Ability to clear edits over 100 claims a day. Follow up with mailings letters to insured concerning benefits

United Surgical Partners

Patient Account Representative

03/2017- 01/2018

Follow up on unpaid Surgical claims providing documentation medical records to support the service. Customer service with insurance and patients Appealing claim when necessary. Verification of plan eligibility. Mailing appeal letters to insurance carriers for reconsideration on denied claims.

Optum360 United Healthcare

Patient Account Representative

05/2015-04/2016

Follow up on hospital Dignity Health Claims rebilling posting payments appealing denied Hospital charges. Familiar with Medicare’s system Part A and B plans hospital Dignity Health Sacramento

Mercy Hospital St Louis

Patient Account Representative

07/2012-10/2015

Hospital Medicare part A and B follow up of claims Customer service provided to patients on accounts. Completion of spreadsheets for outstanding balances on claims. Posting of medical payments to accounts. Verification of eligibility on patients plans for billing accuracy.

EDUCATION

High School Diploma 1975

Colorado University On-line 2 years (Medical Billing,Coding

AWARDS AND ACKNOWLEDGEMENTS

Success in New project completing implementation and production.

Medical Terminology

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