CARMEL YODER
Kissimmee,USA
Summary
Seeking a rewarding career in the healthcare finance industry, where I can apply my exceptional analytical skills, interpersonal and leadership skills as well as provide compassionate service to patients, healthcare providers and other stakeholders in the healthcare industry
Revenue cycle professional with strong background in managing billing, coding, and collections processes. Proven ability to enhance team performance and streamline operations to achieve optimal financial results. Known for effective collaboration, adaptability, and reliability. Skilled in revenue cycle management software, regulatory compliance, and customer service.
Overview
20
20
years of professional experience
Work History
Revenue Cycle Specialist - Cash Applications (Work at Home)
Walgreens Specialty Pharmacy
04.2020 - Current
- Generate reports related to accounts receivables on patients’ accounts
- Apply payments to patients’ accounts accurately and in a timely manner
- Review Explanation of Benefits (EOB) or Remittance Advises received from insurance payers to make sure payments are applied accurately
- Comply with HIPAA regulations when processing payments for patient’s accounts
- Participate in team efforts to improve the company’s accounts receivable turnover ratios
- Respond to internal emails to resolve patient payment issues
- Navigate Assurance, Availity, Change Healthcare and other insurance portals to access EOB and verify payments from insurance plans
- Coordinate tasks with the company’s outsourced BPO to meet targets
Claims Assistant - Worker’s Compensation and Guest Claims
Rose International, Inc.
06.2019 - 01.2020
- Managed accounts payable and assured timely payment of invoices to claimants and vendors
- Performed other administrative tasks as assigned by adjusters and Claims Department team leader
- Reviewed, compiled and transmitted medical records as requested by providers or by the legal department
- Processed claims for guests who experienced bodily injuries or property damage/loss while at the Disney parks
- Processed specialist referrals and coordinated medical appointments for worker’s compensation beneficiaries
Specialty Pharmacy Service Representative
A Line Staffing Solutions
01.2019 - 04.2019
- Assisted patients to order and deliver their specialty medications
- Processed electronic claims to insurance payers
- Assisted patients needing copay assistance
- Communicated with appropriate departments such as the pharmacy team, benefits verification team and billing to expedite patient requests
- Resolved patient issues regarding delays in medication deliveries, tracked orders for patients, provided accurate information regarding claim rejections due to insurance restrictions or prior authorization requirements
- Provided excellent customer experience by showing empathy and compassion
- Assisted in completing work lists to ensure timely deliveries of medications
- Documented all inbound and outbound calls by entering all patient information into the CRM database
Medical Referral Specialist
TTEC for Cedars-Sinai Hospital, CA
09.2018 - 11.2018
- Provided a concierge level of service to consumers calling regarding medical appointments and insurance information
- Complied with all HIPAA regulations for patient information confidentiality
- Documented all inbound and outbound calls into the CRM system accurately
- Identified consumer needs based on phone conversations and provided appropriate resolutions
- Set medical appointments, created physician referrals for patients, and ensured proper communication of accurate data to both consumers and physicians
Sr. Provider Resolution Specialist
UnitedHealth Group for Oxford Plans
06.2016 - 07.2018
- Managed calls related to medical insurance benefits and eligibility verification, claims and appeal status, requests for authorizations for medical procedures from health providers
- Complied with all HIPAA regulations for patient information confidentiality
- Conducted research using available resources to address various situations and resolve caller issues
- Provided options to callers to quickly resolve issues and create positive customer experience
- Made outbound calls to providers whenever needed
- Collaborated with other team members and provided assistance on data gathering and issue resolution as needed
- Delivered quality results and adhered to company policies for performance metrics
- Was part of the Training Team sent by United Healthcare to Manila, Philippines on Dec 2017-Feb 2018 to train 50 newly hired Optum BPO agents on health insurance benefits and claims and customer service
- Reviewed instructional materials to provide a more comprehensible training experience
- Encouraged a training environment that aimed at motivating trainees to reach optimum performance
Card Services Representative
Suncoast Credit Union
09.2015 - 06.2016
- Responsible for updating cardholders’ information on bank database
- Processed account holders’ requests for credit card renewals, balance transfers, travel notices and requests for block exceptions on credit cards
- Provided various customer support such as processing returned mail, ordering convenience checks for card holders, waiving of late fees, and other services requested
- Attended to customer service requests over the phone such as inquiries on credit card status, balances, and payment concerns
- Processed requests for investigations from credit union members for fraudulent transactions
Administrative Specialist (Work-at-Home)
WODToys, LLC
11.2014 - 05.2015
- Provided administrative support to the CEO of the company for daily business operations
- Coordinated online meetings and appointments with vendors, employees and other stakeholders
- Provided research assistance to business development team
- Utilized the company collaboration software to help manage projects and monitor progress of assigned tasks
- Prepared an employee training manual for future virtual staff
- Provided customer support to buyers through phone and email
- Responsible for preparing and disseminating routine reports such as sales, inventory and expense reports
- Handled incoming and outgoing correspondences with employees, buyers, outsourced manufacturers and logistic company
- Managed inventory logs and coordinated with logistics vendors to keep inventory updated
- Prepared accounts receivables/payables end of month reports
- Ensured high corporate social media visibility for the company through regular postings on Facebook, Instagram and Twitter
Business Development Officer
Baypeak Grain Traders Inc.
08.2005 - 11.2014
- Identified market trends for grains and commodities for local and international trade
- Coordinated with suppliers and logistic companies for delivery of goods to buyers
- Prepared documents related to trade activities such as purchase orders, buy/sale contracts, and invoices
- Trained administrative and sales staff to ensure excellent customer service
- Monitored stock inventory
- Prepared monthly accounting reports
- Handled all incoming and outgoing communication with vendors and customers
Education
Master of Business Administration -
Capella University
09.2024
BS Business - undefined
Capella University
01.2022
Career Diploma (with Honors) - Medical Billing & Coding
Ashworth College
03.2018
Skills
- Demonstrates excellent organization and time management skills Capable of multi-tasking with minimum supervision Self-motivated and able to accomplish tasks and meet expectations Keen attention to details and ability to synthesize information Efficient team collaboration and leadership qualities
- Excellent verbal and written communication skills Accounting skills Proficient in MS Office (Word, Excel, Powerpoint, Sharepoint and Outlook) 60 wpm typing skill, proficient in 10-key numeric keyboard
References
Available if Needed
Affiliations
- Healthcare Financial Management Association (HFMA) Member since 2021
- National Society of Leadership and Success (NSLS) Member since 2021
Timeline
Revenue Cycle Specialist - Cash Applications (Work at Home)
Walgreens Specialty Pharmacy
04.2020 - Current
Claims Assistant - Worker’s Compensation and Guest Claims
Rose International, Inc.
06.2019 - 01.2020
Specialty Pharmacy Service Representative
A Line Staffing Solutions
01.2019 - 04.2019
Medical Referral Specialist
TTEC for Cedars-Sinai Hospital, CA
09.2018 - 11.2018
Sr. Provider Resolution Specialist
UnitedHealth Group for Oxford Plans
06.2016 - 07.2018
Card Services Representative
Suncoast Credit Union
09.2015 - 06.2016
Administrative Specialist (Work-at-Home)
WODToys, LLC
11.2014 - 05.2015
Business Development Officer
Baypeak Grain Traders Inc.
08.2005 - 11.2014
BS Business - undefined
Capella University
Career Diploma (with Honors) - Medical Billing & Coding
Ashworth College
Master of Business Administration -
Capella University
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