Carmen C. White
West Haven,CT
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
22
22
years of professional experience
1
1
Bilingual English/Spanish
Work History
Payer Audit Specialist
Yale New Haven Health System
07.2013 - Current
- Current Job responsibility
- Performs all functions of Audit payer specialist position to ensure timely audit or medical records request fulfilled accurate, and HIPPA compliant.
- Fulfillment of requests for clinical correspondence and financial records from all categories of payers, regulatory agencies, and internal auditors on needed basis
- Performs variety of specialized, duties including independent prioritization of daily workflow.
- Manage EPIC work queues triages and troubleshoots correspondence; monitors and expedites request received in
- EPIC work que from billing department
- Identify and escalate issues with EOB and claims data and manage interoperability work queues for CCD exchange.
- Assist billing department by directing correspondence to correct department.
- Assist Utilization Review department by making follow-up phone calls or check appeals status on Availity provide portal
- For numerous insurance companies
- Up-date EPIC utilization review work ques with appeal status
- Obtained by phone or Availity Essentials Provider
- Portal appeals status filled for Claims, Authorization, and utilization review.
- Proficient in knowledge of how to use Payer portal to upload medical records, obtain claims, or audit status upload appeals for review.
- Proficient in updated EPIC Work Ques, deferred or complete for billing, professional billing, one content, one base, claims -utilization review.
- Proficient in excel, adobe standard, and professional.
- DMZ upload for external auditor, insurance payer, and Office of Inspector General US Department of Health
- Expert in EPIC module one content matching scan to har billing number
- Assisting SBO in updating account receivable accounts
- Very flexible, can adapt to change easily, and work extremely well with others.
- The transition from on-sight to remote work within 2-week time
- I successfully transitioned from on-sight to remote without missing ADR or denial audit preset timeframe.
- I quickly learned and leveraged technology available.
- Coordinate on-demand support to outsourcing billing senior manager.
- Converting medical records into pdf for uploading medical records files into DMZ for appeals review.
Medical records service representative II
Yale New Haven
09.2001 - 07.2013
- Reviewed all requests for copy of medical records (paper and EHR), determined if required information needed, and ensured that authorization or request was HIPPA compliant.
- Provided -Customer service answered phones and provided status of medical records request.
- To patients, insurance companies, life insurance companies, state of Connecticut, doctors' offices, and any walk-in requestors, subpoenas, and search warrants to obtain patient information triaged, ensuring all legal signatures were compliant.
- Input and output medical request's information into Yale database, process requests using all Yale New Haven Hospital computers/E.H. R System.
- Maintained confidentiality of all medical records and sensitive information to comply with HIPAA regulations.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Scanned medical records in digital format for easy retrieval and accessibility.
- Supported medical staff by providing organized and accurate medical records.
- Assisted in preparation of medical records to release to other medical facilities requesting for patient history and information.
- Maintained patient confidence by keeping patient records information confidential.
- Maintained patient records systems by archiving, scanning and indexing important documents and files.
- Printed and photocopied documents to provide patients with copies of medical records.
- Responded to patient inquiries to provide information and details of medical records.
- Analyzed complex medical records to identify discrepancies in accuracy and completeness.
- Input data into computer programs and filing systems.
- Verified accuracy of patient information in medical records.
- Scanned and uploaded medical records into electronic medical records system.
Education
No Degree - Web Design
Coursera-project Network
Online02.2023
No Degree - UX Design
Coursera -Google
Online 02.2023
AAHAM -Certified Revenue Cycle Specialist -Institutional- CRCS-I -
AAHAM
Online02.2020
Bachelor of Science - Health Information, Management
ALBERTUS MAGNUS College
New Haven, CT05.2015
EMPLOYEE OF THE MONTH -
Yale New Haven Hospital
High School Diploma -
West Haven High School
West Haven 06.1989
Skills
- Re-organized Payer audit commercial insurance workflows to improve workflow with payer audit manager
- When payer audit department became 100 percent remote Developed and implemented new procedures
- Expert in EPIC system
- Expert in MRO electronic health record system
- Expert in Adobe creating pdf files and transmission
- Expert on use of Payer portal's ability to understand how to use them To obtain status or transmission of Data
- Ability to multitask in fast-paced and daily changing environment
- Experience customers service skills, great communicator with internal department, external facilities, and Coworkers
- Strong analytical skills and creative skills
- Mastered use of external systems, MRO, Appeals Master-Intersect healthcare, NGS, Payer Watch Veracity,
- Mapped Insurance companies withing in Veracity system SSI, Greater New yorker tracker system,
- Expert in use of State of Connecticut portal, and 3M
- IT liaison monthly computer software testing
- Auditing experience in Clinics within City of New Haven
- Outreach worker on Needle exchange health care van Provided Case management services
Timeline
Payer Audit Specialist
Yale New Haven Health System
07.2013 - Current
Medical records service representative II
Yale New Haven
09.2001 - 07.2013
No Degree - Web Design
Coursera-project Network
No Degree - UX Design
Coursera -Google
AAHAM -Certified Revenue Cycle Specialist -Institutional- CRCS-I -
AAHAM
Bachelor of Science - Health Information, Management
ALBERTUS MAGNUS College
EMPLOYEE OF THE MONTH -
Yale New Haven Hospital
High School Diploma -
West Haven High School
Similar Profiles
Faith KozikowskiFaith Kozikowski
Outpatient Nurse Coordinator at Yale New Haven Health SystemOutpatient Nurse Coordinator at Yale New Haven Health System
Kristen NievesKristen Nieves
Supply Coordinator at Yale New Haven Health SystemSupply Coordinator at Yale New Haven Health System
Sasha AyalaSasha Ayala
Patient Financial Access Specialist at Yale New Haven Health SystemPatient Financial Access Specialist at Yale New Haven Health System
ERICA RIVERAERICA RIVERA
Care Center Manager at Yale New Haven Health SystemCare Center Manager at Yale New Haven Health System
JENNA DECECCHIJENNA DECECCHI
Licensed Clinical Social Worker at Stokes Counseling ServicesLicensed Clinical Social Worker at Stokes Counseling Services