CARNETTA SIMS
Pleasant Grove,Alabama
Summary
Proven professional with diverse management, claims, auditing, training, credit analysis, and collections experience. Strong communication skills, both orally and written. Strong analytical and problem solving skills. Proven ability to oversee projects from start to finish. Dedicated professional with a history of meeting company goals and client satisfaction. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
46
46
years of professional experience
2
2
Certifications
Work History
Sr. Claims Examiner /Claims Manager
ALTERNATIVE INSURANCE RESOURCES
Vestavia Hills, AL
03.2006 - Current
- 2010 promoted to manager over the Claims and the Customer Service Department
- Overseeing and training of claim examiners and customer service personnel
- Manage workflow and performance to meet turnaround goals and objectives
- Create standard policies and processing procedures based on regulatory guidelines
- Collaborate with the IT Department on system improvements to comply with governmental mandates
- Review and edit group plan documents, provider relations, and contract negotiations
- Handle high dollar claims, appeals determination, adjustments, voids, refunds, provider relations, and foreign claims.
- Implemented and built medical plans in the Medi-claims healthcare system.
Academic Records Coordinator
ECA, VIRGINIA COLLEGE
Birmingham, AL
09.2010 - 01.2011
- While working part-time for Alternative Insurance, assisted Manager of Academic Records in updating/maintaining academic administration database system
- Provided customer support to all Registrars
- Audited locations to ensure compliance with governmental regulations
- Trained new Registrars on the Campus Vue database.
Collection Specialist/Retail Sales (Part-time)
LORCH’S WEST JEWELS
Bessemer, AL
11.1990 - 11.2010
- Analyzed credit data and financial statements to determine degree of risk involved with extending credit
- Accounts receivable and collections
- Sales
Medical Claims Examiner
WHEELER COMPANY
Birmingham, AL
03.1999 - 03.2006
- Processed medical claims based on plan documents, as well as maintained and delivered outstanding provider relations with physicians
- Processed Medicare and COB claims per regulatory and contract guidelines.
- Customer Service
Help Desk Coordinator & Office Coordinator
CP & T SOLUTIONS, INC
Vestavia Hills, AL
03.2001 - 09.2003
- Coordinated responses to subscribers’ coding and reimbursement questions
- Performed and reported multi-specialty medical chart audits
- Handled remote coding of ER and surgical records
- Prepared client invoices and reports.
Education
Bachelor of Science Degree - Business Management
UNIVERSITY OF PHOENIX
Associate Degree - Office Administration
LAWSON STATE COMMUNITY COLLEGE
Skills
Strategic planning
Staff Management
Coaching and mentoring
Teambuilding
Organizational skills
MS Office
Account management
Negotiation
Critical Thinking
Certification
Certified Loan Signing Agent - Notary Public
Timeline
Academic Records Coordinator
ECA, VIRGINIA COLLEGE
09.2010 - 01.2011
Sr. Claims Examiner /Claims Manager
ALTERNATIVE INSURANCE RESOURCES
03.2006 - Current
Help Desk Coordinator & Office Coordinator
CP & T SOLUTIONS, INC
03.2001 - 09.2003
Medical Claims Examiner
WHEELER COMPANY
03.1999 - 03.2006
Collection Specialist/Retail Sales (Part-time)
LORCH’S WEST JEWELS
11.1990 - 11.2010
Bachelor of Science Degree - Business Management
UNIVERSITY OF PHOENIX
Associate Degree - Office Administration
LAWSON STATE COMMUNITY COLLEGE