Carla Parker
Eureka,CA
Summary
Versatile Healthcare Administrator committed to maintaining high customer satisfaction by providing friendly, fast service for all needs. Skillful in researching and resolving billing discrepancies and claims. Disciplined and energetic professional well-versed in medical claim appeal processing, clinical relations, and medical billing.
Overview
15
15
years of professional experience
Work History
Provider Relations Coordinator, Medical Contracts
Kaiser Permanente
07.2014 - 07.2015
- Maintained accurate provider databases, ensuring up-to-date information was readily available for internal use and external reporting purposes.
- Participated in industry conferences or events, representing the organization professionally and developing valuable networking connections with potential providers.
- Processed 30-45 disputes weekly for both professional and hospital providers including ABA Therapists, Nephrologists, Internists and SNF providers.
- Received Quality and Compliance awards for most disputes processed (150+) with minimal training in August and November 2014.
Provider Reimbursement Specialist, Medical Audit
Kaiser Program Offices
08.2005 - 07.2014
- Utilized coding methodologies to analyze clinical data, verify billing accuracy and to support cost containment.
- Identified and presented special event cases to Quality Improvement supervisors for evaluation prior to yearly NCQA Audits.
- Supported company objectives by maintaining compliance with all relevant state and federal regulations governing medical billing practices.
- Excelled in claims production reviewed minimum 90 claims per day and reduced processing cost by 3%.
Out of Area Benefits Coordinator, UR Department
Kaiser Foundation Health Plan, Inc.
08.2000 - 08.2005
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Assigned cases to Nurse Case Managers for repatriation of Kaiser members hospitalized at Out Of Plan Facilities
- Negotiated prompt pay discounts from 5%-10% with non-contracted facilities.
Education
ICD-9, ICD-10, CPT Coding
American Academy of Professional Coders
Salt Lake City, UT12.2015
Medical Terminology II, Course Completion
Chabot College
Hayward, CA08.2002
Skills
- Healthcare Industry Knowledge
- Analytical Thinking
- Provider relationship management
- Teamwork and Collaboration
- Policy Interpretation
- Organizational Skills
- Adaptability and Flexibility
- Microsoft Office
- Computer Proficiency
Timeline
Provider Relations Coordinator, Medical Contracts
Kaiser Permanente
07.2014 - 07.2015
Provider Reimbursement Specialist, Medical Audit
Kaiser Program Offices
08.2005 - 07.2014
Out of Area Benefits Coordinator, UR Department
Kaiser Foundation Health Plan, Inc.
08.2000 - 08.2005
ICD-9, ICD-10, CPT Coding
American Academy of Professional Coders
Medical Terminology II, Course Completion
Chabot College
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