Healthcare Revenue Cycle
Resume:
SHIMENA CARTER
College Station, TX 77048 Cell :979-***-**** ad3p7j@r.postjobfree.com
Career Objectives
To obtain a position utilizing my knowledge of administration processes. My focus is to move towards job security / advancement while using my core values of organization, flexibility, time awareness, and persistence.
Summary of Qualifications Over 20 yrs patient/member awareness, computer proficient, over 15 years in healthcare industry, Knowledge of: eligibility, benefits, charge entry, electronic/paper claim submission, clearing house reporting, revenue collections (hospital and physician), soft patient collecting, company write-offs and multiple company cleanup projects
Work History
Enable Comp -October10,2022-current
Revenue Specialist
Provider Physician and Hospital billing details
Confirm claims details Motor Vehicle Claims
Determine if patient has Med pay coverage
Confirm All insurance details (Via email, fax, website or patient)
Coram CVS Home Infusion - December 27,2021-July 03,2022 (companywide lay off)
Patient Care Coordinator
Assess patient needs and document referral requests for coordination of care.
Provide information pertaining to infusion drug, supplies and services
Coordinate with the Insurance Verification Team to process patient details and collect benefit coverage information.
Relay insurance coverage to referral sources and patients and discuss forms required for billing with patients.
Process orders from referral sources and patients, responding to phone and fax inquiries, and resolving patient complaints
Resolve reimbursement issues with patient accounts, sales team, and management
Startek/IRS (contract CDC project) – May 24,2021-August 02,2021
Inbound calls
Assisting customers in rebate/advance process
Providing IRS tools
Website review
Complaint submission
Conifer Healthcare-August 21,2020-May17,2021
Patient account review
Eligibility/ online web portal/ electronic data base/patient contact/facility contact
Billing submission/rebill review
Coordination of benefits review
Claims follow up/ online portal/clearinghouse/ manual calls to insurance
Submit claims for internal disputes
Under payment reconsideration to insurance
Bill invoices to patient
Received faxes, phone calls, faxes for claim details
Computershare January 13,2020-March 12,2020
Inbound Customer Calls
Customer Complaints
Share Service review of accounts
Transfer request
Deceased review of account
Deceased transfer of shares
Company purchase/Sale Options
Corporate Action Reviews
Patient Financial Services (PFS) August 26, 2018-November 18, 2019
Collector/Biller
Submits patient bills through the billing software for patients' hospital accounts
Follows up w/insurance carrier for prompt reimbursement
Inbound calls from multiple Insurance companies for account resolution
Contact patient for additional account information
Biller/collector must demonstrate attention to detail, strong work ethic,
Work independently, demonstrate a high tolerance for interruption of tasks, will be able to multi-task
Ability to refocus to task completion while maintaining
The biller/collector must be articulate and persuasive while being sensitive to patients' needs
Apex/ McKesson Specialty Health March 27, 2017- August 24, 2018
Eligibility Coordinator Position/ Quality Assurance Specialists - CMS Oncology Care Model (OCM)
Ensures practice compliance and performance for specific components of the CMS OCM –
Must understand and follow specific contractual requirements for eligibility and Enrollment
Navigate through multiple versions of electronic medical records and practice Management systems in addition to internal IT systems
Utilizes knowledge of oncology terminology
Understanding of Oncology Chemotherapy treatments (IV/Oral /Hormonal)
Verification of insurance benefits
Integrity and accuracy of data entered into IT systems daily
Assist in all aspects of reviewing and identifying practice performance –
Identifies inaccuracies in patient enrollment
Identifies inaccuracies in practice electronic medical record documentation
Identifies inaccuracies in practice submission of clinical data
Outreach to provider to obtain missing clinical data
Populate all data in Salesforce
Analyzes, compiles, and reports daily audit findings –
Gathers and records daily findings in specified format
Maintains accuracy of data submitted on reports and spreadsheets
Assists and utilizes recorded findings to present problem resolutions for the practice
Quantify findings that have been recorded
The National Radiology Network Houston, Texas
Claims Resolution Specialist, Jan 03, 2011 -January 3, 2018
Monthly view of revenue cycle
Biller/coder of radiology services
Billing claims to most major insurance companies
Reconciling of daily claims
verifying insurance eligibility
Entering patient demographics
Posting records to the billing system
In/outbound calls to facilities/Providers
Appeal denied claims
Working correspondence from insurance companies/third party administrators
Invoicing patients/soft collections
Credentialing verification of new contracts
Education
University of Central Oklahoma, Edmond, Oklahoma
Bachelor’s Degree -Jan 2008 - May 2010 Major: General Studies
Minor: Sociology GPA: 3.29
Oklahoma City Community College, Oklahoma City, Oklahoma
Associates Degree Aug 2000 - Dec 2009 Major: Psychology
Minor: SociologyGPA:2.7
References
Gary Vasichko -Chief Financial Officer 11811 N Freeway suite 200 Houston TX 77060 832-***-****
LaCrisha Johnson - Team Lead UMR/Harrington Health 6808 Woodlake Dr Okc, Ok 73132 405-***-**** ad3p7j@r.postjobfree.com
Melissa Lara – Team Lead Meddata/Alegis ad3p7j@r.postjobfree.com 832-***-****
Veronica Melgoza-Team Lead Cvs Coram ad3p7j@r.postjobfree.com 916-***-****
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