Carline St. Brice
Orlando
Summary
Professional and results-driven healthcare coordinator with substantial experience in pre-certification processes. Skilled in navigating complex insurance protocols, ensuring compliance, and maintaining accurate documentation. Strong focus on team collaboration, adaptability, and achieving targeted outcomes. Known for reliability, effective communication, and problem-solving abilities.
Overview
13
13
years of professional experience
Work History
Lead Precertification Coordinator
Orlando Orthopedic Center
Orlando, FL
03.2016 - Current
- Supervise and lead a team of precertification coordinators, ensuring the timely processing of insurance authorizations for orthopedic surgeries, procedures, and imaging.
- Liaise with insurance companies to secure pre-approvals for orthopedic procedures such as joint replacements, spinal surgeries, and diagnostic imaging
- Review medical records, procedure codes, and clinical documentation to ensure timely and accurate submission of pre-certification requests to insurance companies.
- Address denials and submit appeals with proper documentation to obtain necessary authorizations.
- Maintain up-to-date knowledge of insurance policies and regulatory changes to ensure compliance with state, federal requirements.
- Serve as the main point of contact for physicians, patients, and insurance companies regarding authorization issues and follow-up.
- Train and mentor new staff on pre-certification processes, insurance guidelines, and patient care coordination.
- Collaborated with orthopedic surgeons and clinical staff to gather necessary documentation, including medical records and diagnostic reports, for submission to insurers.
- Assisted with the resolution of insurance denials by reviewing cases, correcting errors, and resubmitting claims with additional documentation.
- Scheduled patient appointments and surgeries based on approved insurance coverage, ensuring a smooth transition of care.
Medical Assistant/Clinical Research
Neurological Services of Orlando
Orlando, FL
03.2014 - 03.2016
- Provided administrative support to physicians and office staff.
- Checked patients in and out of appointments, obtained vital signs, and medical history.
- Collected co-pays, completed prior authorizations, submitted referrals and reviewed insurance verification for each patient.
- Office tasks include filing, scheduling appointments, faxing, and submitting prescriptions electronically.
- Assisted in data collection, entry, and quality control to ensure accuracy and consistency in research findings.
- Managed patient screening and eligibility assessments based on inclusion/exclusion criteria.
- Monitored patients during clinical visits, ensuring safety and adherence to study protocols.
- Coordinated with clinical teams and external vendors for lab tests, imaging, and other research-related activities.
Medical Assistant
Mid-Florida Medical Group
Winter Park, FL
02.2013 - 01.2014
- Assisted with patient intake, providing clear instructions and ensuring patients are informed about their treatments.
- Assisted with patient intake procedures, ensuring accurate data collection and efficient workflow.
- Perform routine clinical duties, including taking vitals, administering injections, and drawing blood.
- Maintain accurate medical records in compliance with HIPAA regulations using [EMR/EHR Software].
- Scheduled appointments and manage patient flow to ensure a smooth and efficient practice environment.
- Processed insurance claims and billing for services.
- Assisted in clinical procedures, supporting physicians with examinations and patient care tasks.
Education
B.S - Criminal Justice – Criminology
Southern New Hampshire University
Manchester, NH05.2022
Medical Assistant - Certificate of Completion - Medical Assisting Program
Eastwick College
Ramsey, N.J.04.2009
Skills
- Expertise in HCPCS, CPT, and ICD-10 coding
- Multi-specialty medical billing
- EMR systems, Centricity, e-Clinical Works, Exscribe, NextGen, Microsoft Office, Word/Excel/Outlook, Medical Terminology
- Strong verbal and communication skills, Team player, fast learner, detail oriented, & organized
- Good customer service and leadership skills
- Ability to perform multiple and diverse tasks simultaneously
- Maintains detailed knowledge of practice management, electronic health records and other computer software as it relates to job functions
- Strong team building skills, with the ability to influence, lead, teach, train, counsel, and coach to accomplish organizational goals
- Denial Management & Appeals
- Healthcare Compliance & Regulations
- Staff Training & Leadership
Affiliations
- Member, [Relevant Organization, such as American Academy of Professional Coders]
- [Other memberships]
Timeline
Lead Precertification Coordinator
Orlando Orthopedic Center
03.2016 - Current
Medical Assistant/Clinical Research
Neurological Services of Orlando
03.2014 - 03.2016
Medical Assistant
Mid-Florida Medical Group
02.2013 - 01.2014
Medical Assistant - Certificate of Completion - Medical Assisting Program
Eastwick College
B.S - Criminal Justice – Criminology
Southern New Hampshire University