Anita Syles
Charlotte,NC
Summary
Dynamic professional with extensive experience in case management and claims processing at Sunlife Financial. Proven ability to enhance documentation accuracy and foster strong customer relationships. Adept at insurance verification and reimbursement analysis, consistently delivering results while maintaining compliance with industry standards. Committed to supporting clients through effective communication and advocacy.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Case Specialist- Remote
Sunlife Financial
Portland, ME
11.2022 - Current
- Collaborated with team members to process claims and assist in resolutions.
- Conducted research to gather necessary documentation for case evaluations.
- Participated in training sessions to learn company policies and compliance standards.
- Assisted clients by answering inquiries and providing information on policies.
- Supported case management by organizing and maintaining client files.
- Managed communication between clients and internal departments for clarity.
- Maintained detailed records of all case activities using appropriate software systems.
- Assigned caseloads based on program guidelines and individual needs.
- Provided support to clients through counseling and advocacy services.
Billing Specialist-Remote
Curo
Mooresville, North Carolina
08.2020 - 11.2022
- Processed customer invoices using billing software to ensure timely payments.
- Reviewed billing discrepancies and resolved issues with clients efficiently.
- Maintained accurate records of transactions and customer interactions consistently.
- Communicated with customers regarding billing inquiries and payment options promptly.
- Answered customer inquiries regarding billings, payments, account status.
- Resolved discrepancies between customers' remittances and invoices received.
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Verified insurance coverage and identified third-party payers for billing purposes.
Case Manager-Remote
Allcare Plus Pharmacy
Northborough, Massachusetts
07.2019 - 06.2020
- Coordinated patient care plans with healthcare providers and pharmacy staff.
- Maintained accurate patient records in compliance with regulatory standards.
- Maintained accurate case records and documentation according to agency guidelines.
- Participated in regular team meetings and in-house training sessions to boost group effectiveness.
- Compiled reports on cases and submitted them to supervisors as required.
- Maintained logs and electronic client records following department and agency policies for effective monitoring.
Intake Coordinator
Kindred at Home
Charlotte, NC
12.2017 - 03.2019
- Managed appointment scheduling for new and existing patients.
- Coordinated patient intake processes for home health services.
- Collected and verified patient information for accuracy and completeness.
- Assisted patients in understanding insurance coverage and benefits options.
- Coordinated the intake process for new clients, including scheduling initial assessments and providing necessary paperwork.
- Maintained accurate records of client intakes in electronic database system.
- Maintained organized records of patient interactions and documentation processes.
Senior Reimbursement Specialist
AmerisourceBergen
Charlotte, NC
11.2014 - 05.2017
- Processed reimbursement claims for pharmaceutical products accurately and efficiently.
- Reviewed patient accounts for eligibility and coverage under insurance plans.
- Collaborated with healthcare providers to resolve billing discrepancies and inquiries.
- Supported audits by preparing necessary documentation and reports for review.
- Maintained up-to-date knowledge of industry regulations and payer requirements.
- Maintained records of all reimbursements received from providers according to company guidelines.
- Reviewed, analyzed and processed provider reimbursement claims for accuracy and compliance with all applicable regulations.
Education
Some College (No Degree) - Health Care Coordinator
Central Piedmont Community College
Charlotte, NCSkills
- Case management
- Claims processing
- Documentation accuracy
- Insurance verification
- Reimbursement analysis
- Customer relationship management
Certification
- Series 63
- Independent Adjuster Worker's Compensation
Timeline
Case Specialist- Remote
Sunlife Financial
11.2022 - Current
Billing Specialist-Remote
Curo
08.2020 - 11.2022
Case Manager-Remote
Allcare Plus Pharmacy
07.2019 - 06.2020
Intake Coordinator
Kindred at Home
12.2017 - 03.2019
Senior Reimbursement Specialist
AmerisourceBergen
11.2014 - 05.2017
Some College (No Degree) - Health Care Coordinator
Central Piedmont Community College
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