Quality Assurance Customer Service

Carol McGruder

Upper Marlboro, MD ***** 240-***-**** ******@*****.***

PROFESSIONAL SUMMARY

With a robust background in project management and healthcare operations, I excel in medical billing, claims management, and client relations. My expertise spans account management and quality assurance, all supported by proficiency in Microsoft Office and Cerner Implementation. Known for my strong customer service and client relation skills, I effectively navigate revenue cycles and utilize health care solution software to optimize processes, demonstrating a unique blend of technical acumen and soft skills in fast-paced environments.

WORK EXPERIENCE

Credit Collections Representative

Children’s National Hospital Washington, D.C. 2005 - July 2025

Analyzed and resolved denial correspondence from insurance companies, evaluating claim denials using codes and prioritizing them for resolution.

Proactively followed up on submitted claims via telephone or web to address payment issues promptly.

Managed a high volume of denials to optimize reimbursement.

Administered financial documentation and generated correspondence related to claims and appeals.

Conducted research to identify denial reasons, collecting necessary documentation for appeal processes.

Ensured accuracy in demographics, insurance, and charge entries to maintain system compliance.

Monitored error trends, reporting issues to management, and participated in special projects for insurance follow-up.

Validated and verified information for decision-making and documentation purposes.

Coordinated with parents regarding insurance payments and information needed for claims processing.

Prioritized high-balance accounts to facilitate quicker payments.

Identified and reported trends in denial and appeal claims, collaborating with management on strategies to ensure successful claim processing.

Assisted coworkers and recommended write-off adjustments, attaching necessary documentation for processing.

Updated patient registrations, verified insurance benefits, and obtained necessary service authorizations, ensuring correct insurance information through patient follow-up.

TECHNICAL & SOFT SKILLS

Project Management

Medical Billing

Claims Management

Collections

Customer Service and Client Relations

Account Management

Document Control

Quality Assurance

Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

Cerner Implementation

PPM Software

Revenue Cycle

Availaty

EDUCATION

High School Diploma Havre De Grace High School Havre de Grace, MD

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