DEBBIE CARTER

***** ********* ****** *****

CYPRESS TX 77433

713-***-****

ad1a3y@r.postjobfree.com

CAREER

Seeking employment with a company in the Medical that offers advancement and challenges in a position that I may utilize my skills for the growth of the company with giving excellent service to all customers. Seeking for Full, Part Time and Contract positions.

SOFTWARE / APPS: EXCEL, MICROSOFT WORD, OUTLOOK, NAVINET, AVAILITY, PASSPORT, IEHP, TMHP

AUTO DAILER: ALLOWARE, CUBS, CISCO JABBER

MEDICAL SOFTWARE: ACE, EMR, MEDI-SOFT, BARIATRIC 360, E-CLINICAL WORKS, EPIC, MEDITECH, EPREMIS, MED-ASSETS, CHART MAX, I-SUITE, SOVERA, SHARE, INVISION, LYTEC, ASSURANCE / EPREMIS,

INSURANCE VERIFICATIONS AND CLAIM STATUS PORTALS:

1.Availity

2.TMHP

3.Passport

4.United Healthcare

5.BCBS

6.Aetna

EXPERIENCE; Emergency Room Collections, Urgent Care Collections, Hospital Billing, Anesthesia Billing, Bariatric Billing, Physician Billing, OBGYN, Work Comp, MVA

INSURANCE PAYERS:

ALL COMMERICAL, MEDICARE, MEDICAID, IPA’S, MEDICAL GROUPS

EDUCATION:

High School Diploma

Associate Degree Biblical Studies 2018-2019

Bachelor Degree Biblical Studies 2019-2021

WORK HISTORY

Conifer Healthcare Solutions - Account Representative - 10/2022 to 11/14/2023 – Assignment completed

• Billing and reviewing of 60 plus accounts daily

•Review and refilling of all facility claim rejections foe In-Patient and Out-Patient

•Verification of claims submission by calling payers or verifications of claims using Availity or payers website portals.

•Verification of medical benefits using IEHP, TMHP, AVAILITY, PASSPORT/

•Call to patient regarding insurance or updated insurance information

•Forwarding claims back to facility for HCPCS, Diagnosis and Revenue Code rejections

•Reviewed accounts for overpayemts and refunds to all payers, includes all Commercial insurances, Medicare, Medi-Caid, Medi-Cal, IPA and HMO

Gryphon Healthcare - Houston TX - Medical Collections Specialist - 04/22 - 09/22 (Laid Off)

•Collections for Emergency Rooms, Urgent Care Facilities for Austin Emergency Centers, Beaumont, Pearland, Las Vegas, ER Now and Texas Emergency Care Centers

•Placed out bound calls to collect on outstanding balances owed to coinsurance, self pay or deductibles

•Answered Inbound calls

•Posting of credit card payments over the phone using TranSafe, Pay Trace, Simple Pay

•Verified patient insurance eligibility

•Updated information for MVA and Workers Compensation

•Report daily log of accounts worked and credit card payments received

Cornerstone Staffing – Houston TX. - Remote Reimbursement Specialist- Dec. 2021 – 02/22 (temp assignment)

•Insurance verifications with all commercial, Medicare and Medicaid payers for eye injections to bill claims for reimbursement for drug Eylea. Follow on claims, appeals for higher reimbursement.

•Follow up on claims, appeal for higher reimbursement

•Request authorization for drug injections

Solutions Reimbursement – Richmond Texas Revenue Cycle Medical Biller - July 2018 - August 2021

•Billing and coding of Plastic Surgery claims for DIEP Flaps, Breast Reconstructions, Fat Grafting, Office Visits,

•Provider Enrollments into Availity Software for billing and Receiving Remits for all insurance carriers

•Retrieve all providers payment in Availity

•Follow up on all claims and payments

•Appeals on denied and under paid claims

•Insurance Verification

Request Pre-D

•Request Pre-Certs

•Interact with facilities on authorizations

Acclara – Houston TX

•Account Rep III – October 2015 to 2018

•Billing of hospital In-Patient and Out-Patient claims, Radiology

•Extensive High dollar follow-up

•Insurance verifications using Availity, Navinet and Medicaid web portals. Billing to Medicare, Medicaid, other government payers, Blue Cross Blue Shield, Tricare, Aetna, United Healthcare, and other commercial payers

•Appeals

•Retrieve Medical Records to support claims filings

•Answer in Bound calls

•Placed out-Bound calls

•Experience with modifiers for claim submission

US Anesthesia Partners / Greater Houston Anesthesiology Group – Houston TX

Medical Insurance Rep III – March 2015 – December 2015

•Billing of Medicaid and Medicaid HMO claims and follow up

•Medicaid appeals for anesthesia services

•Correction of procedure codes to reflect medical necessity for In-Patient

•Mailing of patient monthly statements on outstanding balances.

•Insurance Verification for Services

Pediatrix Medical Group – Houston TX

Hospital Associate – October 2014 – February 2015

•Patient Demographics for new patient and new born admitted to the NICU after delivery

•Insurance Verifications of all insurances

•Authorizations for infant delivery and hospital stays

•Billing of charges

•Balancing of all charges entered daily

•Run daily report of charges billed

•Retrieve work sheets from the doctors and nurses in the NICU department

•Answer in-bound calls

Houston Surgical Consultants, Bariatric Surgeons – Houston TX

Billing and Collections Coordinator – May 2012 – April 2014

•Coding and billing patient surgeries with operative reports

•Billing for office visits

•Verification of all insurances for surgical procedures, EGD's, Hernia, Gastric By-Pass, Duodenal Switch, Lap Band, Gastric Sleeve and Revisions

•Verifications to all insurances for office visits

•Schedule appointments

•Billing of patient monthly statements for balances

•Collect co-pays, deductibles and surgery fees

•Post all payment received

Contact this candidate