CARRIE B. WRIGHT

267-***-****

ad2xum@r.postjobfree.com

PROFESSIONAL SUMMARY:

Proficiency in Healthcare and Health Plan terminology, medical coding (e.g., CPT, HCPCS, ICD9, and ICD10, Revenue, DRG, and other relevant medical and industry standards codes. Over 23 years in healthcare operational and claims processing experiences.

EMPLOYMENT HISTORY:

10/2016-3/2020 Operation Quality Auditor

Amerihealth Caritas-Philadelphia, PA

Auditing all claims for processing and claim payment adjusters.

Conduct live audits, performance guarantee audits, random audits, and report on the accuracy in payment, technical, and payee errors identifies system/or operational issues hindering the attainment of quality performance standards.

Audit claims for Medicare/Medicaid including sources Medical Therapy.

Train ten associates and a trainer on Medicare/Medicaid guideline.

06/2013-10/2016 Provider Claim Service Representative

Amerihealth Caritas-Philadelphia, PA

Answering a high volume of calls from provider in appropriate coding trends of issue resulting in payment error and communication to address claim rejection and denial base on claim data.

Aid provider regarding website, registration navigation and member relate issue.

Provide first call resolution to improve the provider with appropriate resource, follow -up closure with the provider who initiate the inquiry.

03/2008-05/2013 Billing Representative/Patient Scheduler

Albert Einstein Medical Center-Philadelphia, PA

Posted payment received from patient and/or insurance carrier.

Posted write off and adjustments according to contracts, policies, and procedures.

Scheduling appointments using the correct protocol established by the cancer department for every member.

Greet Patient, Pre-register or register patient in a courteous and professional manner.

Verify insurance benefits, check to see if they need a pre-cert, authorization, or referral

Required patient signature for required hospital forms.

07/2005-03/2008 Verification of Insurance Benefits (Part-time)

Hahnemann Hospital

Confirm patient health insurance is active, by collecting insurance information and verifying with the insurer.

Verified payment is updated, the deductible and maximum out of pocket has been met.

Handling both incoming and outgoing calls to assist patients with their insurance verification.

03/2003-02/2008 Business Analyst

Independence Blue Cross, Philadelphia, PA

Communication with vendors user to collect information on business process and user requirements.

Document business process and analyze procedure to see if they met changing for business need.

Used continuous improvement tools to evaluate and prioritize process improvement.

09/1996-02/2003 Claim Examiner

Independence Blue Cross-Philadelphia, PA

Key a high volume of claims, verified total charge and balancing charge once keyed and billed.

Posted payment and charge entry resubmission process and rejection.

Credit and refund claim research eligibility claims and review benefits, third-party billing with Medicare, Medicaid, and Subrogation claims.

EDUCATION:

09/1977-06/1980 Diploma

Overbrook High School

Computer Skills: Excel, Microwork, Power Point, Outlook, Spreadsheets, Skype, Word Processing, Email, Epic Web Portal Facet, Performer X Navinet, Integrate Agent Desktop (IAD Phone), Verint, Jivaa, Cotiviti claim inquiry tool, Macess (EXP) right fax and NPI Xwalk