Mercy Health Medical Records
Resume:
Dawn Carter
Claims Analysis
Cincinnati, OH 513-***-**** ad7mu8@r.postjobfree.com
Objective
To obtain a challenging position in a dynamic and innovative organization where I can use my claims processing and analyzing skills.
Experience
Mercy Health Safety Companion 2017-present
Sitting with patients whom are suicidal or homicidal to ensure their safety.
Mercy Health Claim Audit Specialist 2015-2017
Entered in Request and Claim information for Auditing with Commercial and Defense Audit.
Researched information in PA systems Artiva, Data Ark, AS400, to complete a request.
Entered Audit dates for defense audit and high dollar charge audits.
Prepared the invoices and itemized statements that have to be sent for the high dollar charge audits.
Worked closely with the Director.
Scanned in and prepared high dollar charts for Nurses to audit.
Entered in 50 or more accounts for Commercial Audits.
Researched and double checked all work is correct in MAC and RAC.
Mercy Health Front Office Specialist 2014-2015
Scheduled and registered at least 60 appointments with patients face to face and on the phone daily.
Collected copays in the forms of cash, check, and credit card utilizing Rev-springs online payments.
Pulled, filed, and prepared patients charts daily.
Answered up to 3 telephone lines daily.
Clerical Duties such as mailing, faxing, printing, copying, making folders for patients.
Scanned in patient's insurance card, photo Id's, medical records.
Made bank deposits for end of the day deposits.
Accessed Availity and Epic to confirm patient's insurance eligibility.
Contacted Insurance companies to confirm patient's benefits for therapy.
Peer interviewed possible candidates for various positions.
Mercy Health Unit Secretary 2012-2014
Scheduled walk in appointments for radiology such as Xray's Labs
Filed, faxed, made copies..
Answered multiple telephone lines..
Printed out Films/medical records for patients and providers for different radiology procedures.
Mercy Health Advanced Scheduler 2010-2014
Scheduled and pre-registered appointments with patients and provider offices.
Researched ICD-9 and diagnosis codes for medical necessity.
Verified insurance, and authorizations.
Interaction with Hospital departments and personnel, including Cardiology, Vascular, Special Procedures/Cath Lab, and Radiology
Cincinnati Eye Institute-Trak Group AR Follow up Specialist (temporary assignment) 2022-2023
Researched, processed, appealed denied claims for Medicare, Medicaid, worker’s compensation, skilled nursing facilities, Anthem, Humana, All government not just including correction facilities, VA, Tricare for life, VACCN for all markets in Cincinnati and Virginia Markets
Worked in Nextgen system
Kelly Services Claims Processor (temporary assignment) 2021-2022
Researched, processed, appealed denied claims for Medicare, Medicaid, worker’s compensation, skilled nursing facilities, Anthem, Humana, All government not just including correction facilities, VA, Tricare for life, VACCN for all markets in Cincinnati and Virginia Markets
Worked in Nextgen system
Council on Aging Care Coordination Specialist 2018-2021
Team educator
Trained over 3 new employees
Retrieved over 50 calls per day to assist with transportation request. •
Processed suspended clams •
Processed HME, DME, HOME MODIFICATIONS •
Emailed, Faxed, and made calls to providers and clients to follow up on services
Sent out Referrals for personal care services, transportation, home delivered meals, emergency response systems, transportation, adult day services, chore services
Worked closely with care managers to assure client’s needs were being met
Education
Certificate in State Tested Nursing Assistant
Cincinnati State Community and Technical College - Cincinnati, OH 2012
Associate of Arts degree
Cincinnati State Community and Technical College - Cincinnati, OH 2006
Skills & abilities
Customer Service • Clerical Experience • Medical Terminology • Medical Office Experience • Insurance Verification • ICD-9 • Managed Care • Microsoft Excel • Microsoft Word • Epic • AS400• Microsoft Power point • Data collection • Microsoft Office • Medical billing • ICD-10 • Microsoft Outlook • Medical Records • Auditing • Medical Scheduling • Document management systems • Communication skills • Documentation review • Medical records • Workers' compensation law • Medical terminology • ICD-9 • ICD-10 • Cash handling • Epic • HIPAA • EMR systems • Analysis skills• Revenue Cycle
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