Customer Service Home Health
Resume:
Cardel Turner
PROFESSIONAL SUMMARY
Experienced professional well versed with over 15 years of experience in collections, claims, billing, coordination and customer service. Examine claims highly trustworthy, ethical, and committed. Confident and poised in interactions with individuals at all levels. Detail and result oriented, knowledge of software like MS Office, Excel, Strong verbal and written communication skills, is proficient in medical terminology and is comfortable speaking with members and providers.
TECHNICAL EXPERIENCE
Software/Databases: Microsoft Word, Excel
Hardware: AS400
Methodologies: Quality Assurance, Data Management
Others: SMS, IDX, Meditech, Emdeon, Way star, Epic, Flex-care 360 Knowledge of payer websites, Client Advisory, Revenue Cycle, Consulting Claims, Processing/Examiner Processor, Improvement, Contract Negotiations, Relationship Management Customer Service, Service Level Agreements (SLA), Interdisciplinary Teamwork Interpersonal Communication, ICD-9 and ICD-10 codes, Experience with Six-Sigma, Excellence with all Payers, Appeal and denial letter writing, Collections, Claims, Billing, Collaboration
PROFESSIONAL EXPERIENCE
SMOOTH MOVES STAFFING/ST JOSEPH HOME HEALTH Jun 2019 – Jan 2020
Patient Account Representative/Claims Examiner
Billing and Collections for St. Joseph Home Health, call insurance companies on all payers, appeals and rebills on unpaid claims via 1500 and UB04.
Knowledge of Billing software and Experience with payer websites.
Worked with all commercial and managed care payers, Blue Cross/Blue Shield, Aetna, and Cigna and Workers Comp.
Check claim status via using websites, Rebill claims via electronically via billing software.
Claims Examiner.
JUDGE GROUP/AGILON HEALTH Apr 2019 – May 2019
Claims Examiner
Serves medical insurance customers by determining insurance coverage: examining and resolving claims; documenting actions; maintaining customer service and ensuring legal compliance.
Receives PDR’s from providers and determine if claims are eligible for reprocessing for payment or denials.
SUTHERLAND GLOBAL SERVICE Mar 2018 – Nov 2018
Hospital Collections/Claims Examiner
Responsible for third party collections for all Tenet Healthcare facilities.
Utilized knowledge of UB04 and 1500 claims to examine and audit claims to ensure proper Billing.
Utilized knowledge of all payers, HMO, PPO, POS, Medicare and Medical, Managed care Medical.
Knowledge of contracts using web-based applications.
Responsible for insurance follow-up on intimal and aged accounts.
Knowledge and experience with EOBs, rebill claims.
Experienced with all workers compensation claims- Create and wrote own appeals, Claims Adjusting, Experience with Indemnity and TPL claims, Claims examiner.
NAVIGANT CYMETRIX Dec 2015 – Aug 2017
Operations Staff, Claims Auditor
Collections hospital claims make follow up calls with insurance companies negotiate with the proper reimbursement.
Adjusted claims as needed, applied the Six- Sigma Process excellence methodology to Billed Hospital Claims.
Rebill and Denials Management.
Claims Examiner insurance verification.
US RENAL CARE Aug 2015 – Nov 2015
Medical Collections/ Claims Auditor
Collections on outpatient dialysis claims, make follow up calls with insurance companies negotiate with the proper.
Reimbursement on unpaid and underpaid claims.
Knowledge of UB04 and 1500 claim forms.
Adjust claims as needed, applied the Six-Sigma Process excellence methodology to Billed Hospital Claims.
Experienced with all payers claims for accuracy and correct codes for correct reimbursement.
Reviewed and followed up audit suspense reports to ensure all pending claims met departmental turnaround time.
Experience worker's compensation and TPL claims create, edit and write appeal letters, Adjust claims to zero balance worked with all indemnity claims.
ANTHEM BLUECROSS & BLUESHIELD Apr 2015 – May 2015
Claims Auditor/ Claims Customer Service
Auditing claims for all Blue Cross providers.
Call providers to verify and update their practice information for auditing and compliance purposes.
Used the Six-Sigma Process Excellence on claims and provider practices.
Examine claims for state and local compliance laws.
UNITED HEALTH CARE CYPRESS, CA Feb 2015 – Mar 2015
Medicare Part D Coordinator (Contract)
Created appeals for Medicare Part D Prescription Drugs for Expedited and standard processing.
Other various clerical duties as directed.
Claims processing and claims examiner.
Temporary Assignment, Applied Process Excellence Six Sigma per patient appeal letters and billed claims.
Performs data validation audits; Reviews medical record information to identify all appropriate coding.
Reviewing and auditing medical records documentation.
HEALTHCARE PARTNERS Sep 2014 – Oct 2014
Medical Collector
Collections on self-pay accounts, verify patient information and insurance coverage, Follow-up on all payers.
Take payments from patient and make payment arrangements on patient accounts, Rebill claims.
Claims Examiner.
BEACON HEALTH STRATEGIES Jun 2014 – Sep 2014
Claims Processor/Claims Customer Service
Examined and processed professional claims for behavioral health, verify insurance coverage.
Follow-up on healthcare benefits.
Check claims for random audits for compliance.
Verify patient information, claims customer service, verifying claims on file, payment information, resending claims.
Claims Examiner.
PROVIDENCE HOSPITAL Mar 2013 – Jun 2013
Inpatient Hospital Collector
Collections on inpatient hospital claims for all Providence Facilities.
Worked with all payers Government and Non-Government.
Knowledge of UB04s and 1500 claims forms.
Perform random audits on claims to ensure compliance.
Create appeal letters.
Rebill claims.
FREEMAN HEALTH Nov 2012 – Mar 2013
Patient Account Representative
Claims Examiner, Collections on inpatient and outpatient hospital claims, Experience with all lines of insurance, HMO, PPO, POS, Medical, Medicare, Commercial Ins., work denials, re-bill claims, medical records, verify authorizations, and coverage, file appeals, review and calculate proper reimbursements for high dollar accounts.
Call insurance companies for claim status.
Experience with payer web site for claim status and payment information.
Claims Examiner, experience with determine claims approvals and denials, Knowledge of DME Billing and Collections, Knowledge of UB04 and 1500 claim forms.
Applied Process Excellence Six Sigma per patient appeal letters and billed claims that are being billed to the proper payers.
Experience with Home health, Hospice and SNF Billing and Collections Examine claims for correct codes and accuracy, Experience with worker's compensation and TPL claims, create, edit and write appeal letters, Adjust Claims to zero balance, worked with workers compensation and indemnity claims.
CONIFER HEALTH SOLUTIONS Sep 2001 – Jun 2011
Revenue Cycle Specialist III
Claims Examiner, Collections for all Tenet facilities, Follow-up on all line of insurance, HMO, PPO, Commercial, Medicare, and Medi-Cal.
Work denials, medical records, re-bill claims, and verify coverage and authorizations, appeals, review contracts for proper reimbursement, calculate stop loss for high dollar claims.
Experience with payer websites for claim status and payment information, read and analyze EOBS and TARS.
Experience with determine claims approvals and denials, Knowledge of DME Billing and Collections Knowledge of UB04 and 1500 claim forms.
Applied Process Excellence Six Sigma per patient appeal letters and billed claims that are being billed to the proper payers.
Experience with Home health, Hospice and SNF Billing and Collections Examine claims for correct codes, and accuracy, Experience with worker's compensation and TPL and indemnity claims, create, edit and write appeal letters, Adjust claims to zero balance.
EDUCATION
Master of Business Administration; Concentration in Marketing
American Intercontinental University
June 2010 – May 2011
Bachelor of Business Administration; Concentration in Operations Management
American Intercontinental University
April 2009 - June 2010
Associates of Business Administration; Concentration in Business Management
American Intercontinental University
April 2008 - June2009
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