Carlton McClain
Houston
Summary
Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals
Overview
20
20
years of professional experience
Work History
Patient Access Representative II
Memorial Hermann
Houston
02.2024 - Current
- Performed pre-registration functions such as verifying demographic information, obtaining authorizations, and collecting deposits and co-payments.
- Provided assistance to internal departments when needed.
- Maintained confidentiality of patient information in compliance with HIPAA regulations.
- Verified insurance coverage for services provided by the facility.
- Actively participated in team meetings and training sessions.
- Collected co-pays and other payments from patients at time of service.
- Greeted patients and visitors in a courteous and professional manner.
1st Pass Physician Claims Processor
UnitedHealth Group
Minnetonka
02.2022 - 02.2023
- Processing new insurance policies, modifying existing ones and obtaining information from policyholders to verify the accuracy of their accounts.
- Verifying ICD-9 CPT codes and procedure codes.
- Determining if claim should be denied or paid and which proper denial code should be used.
- Contacting physical offices if need be for any additional information.
- Updating data entry and utilizing the Process Instruction for each claim.
- Checking to see what procedure codes have modifiers and the type.
- HCFA/professional (CMS-1500) claims.
- Calculate figures and co-insurance amounts.
- Reading and interpret EOB's and HCPCS codes.
- Understanding of the policy benefits and procedures within the Claims unit.
Supply Chain Management Tech II
Carrollton Regional Medical Center
Carrollton
02.2018 - 01.2022
- Responsible for ensuring consistent and accurate receipt of product return processes with internal systems.
- Closely collaborate with workers in different types of positions. Ensure system with detailed backup documentation and notations including RGA numbers, comments, and accurate tracking of supply data.
- Engagement: Implemented effective tracking of back orders, expiration dates, and product recalls.
- Inventory: Conducted monthly inventory count of all medical supplies and medical equipment.
- Interpersonal: Maintained confidentiality and used strong judgement and discretion by following published policies and hospital procedures. Ensured patients needs were met providing top notch customer service.
- Problem Solving: Identified and resolved problems in a timely manner with the ability to analyze information and develop alternative solutions when issues occur.
Clinical Specialist
Parkland Health
Dallas
09.2014 - 01.2018
- Recruited to supervise daily inventory for supplies and complied and maintained records for all units by ensuring products were stocked.
- Ensure full regulatory compliance with hospital procedures and policies and maintained inventory surplus, product returns and damages; also handle all aspects of restocking and filling orders.
- Engagement: Assisted in reviewing incoming treatment forms and coordinating all administrative tasks.
- Training & Development: Assisted members and providers with explanations and inquiries and handles all claim issues.
- Another key deliverable was my ability to increase speed and accuracy monthly.
- Planning: Utilized sales report to develop stock requirements and ensure all units are fully stocked with the medical supplies needed.
Insurance Verification Specialist
CVS Caremark
Irving
04.2010 - 07.2014
- As an insurance verification specialist, I verified insurance information by phone, web and updated all files with coverage updates in the system of record.
- HIPAA certified.
- I also doubled checked the status of patients' medical insurance and ensured their insurance would cover medical procedures and hospital stays.
- Employee Engagement: Educated patients on their coverage and verified patient information, billing, medical coding and conducting claims examinations.
- Training & Development: Worked closely with patient intake coordinators and a key part to creating a positive experience for our patients.
- Research: Communicated with branch staff to collect additional information on physician orders.
- Scan and uploaded documents from insurance providers into internal system and notified appropriate departments.
Merchandise and Stocking Associate
Wal-Mart
Dallas
08.2005 - 04.2010
- Oversaw loading and unloading shipments and organizing backroom spaces, displays, and stocking shelves.
- Knowledge of operating heavy machinery and ability lift heavy objects more than fifty pounds.
- Work Environment: Used pallets on the back of the warehouse to move to the main floor and restock assigned aisles.
- Sorted and stocking products on shelves and the backroom and engaged with vendors and drivers with a positive attitude.
- Safety: Maintained safety of facility according to company policies and procedures by conducting safety sweeps, following forklift spotting procedures, and followed procedures for handling and disposing of hazardous materials.
Education
High School Diploma -
Faith Family Academy of Oak Cliff
Dallas, TX05-2005
Skills
- Communication
- Collaboration
- Initiative
- Interpersonal leadership
- Change management
- Problem solving
- Time management
- Negotiation
- Team building
- Personal development
- Motivation
- Integrity
- Focus
- Adaptability
- Operational streamlining
- Ambitious
- Results driven
- Customer service
- PowerPoint
- MS Office (Excel, Word, Outlook)
Timeline
Patient Access Representative II
Memorial Hermann
02.2024 - Current
1st Pass Physician Claims Processor
UnitedHealth Group
02.2022 - 02.2023
Supply Chain Management Tech II
Carrollton Regional Medical Center
02.2018 - 01.2022
Clinical Specialist
Parkland Health
09.2014 - 01.2018
Insurance Verification Specialist
CVS Caremark
04.2010 - 07.2014
Merchandise and Stocking Associate
Wal-Mart
08.2005 - 04.2010
High School Diploma -
Faith Family Academy of Oak Cliff
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