Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

CAROL CARSON

Asheville,NC

Summary

Medical Office Specialist with extensive experience at Mission Health, specializing in claims verification and patient communication. Demonstrated success in resolving billing discrepancies and improving patient relations through effective problem-solving. Skilled in Microsoft Office and dedicated to maintaining accurate financial records while ensuring regulatory compliance.

Overview

17
17
years of professional experience
1
1
Certification

Work History

Medical Office Specialist /Surgery Scheduler

Mission Health
Asheville, NC
04.2024 - Current
  • Manage all front office functions including patient relations.
  • Check-in/Check-out
  • Scheduling appointments.
  • Insurance verification
  • Collecting and recording copays (cash and /or charge).
  • Completing the End of Day balance transitions

Medical Reimbursement Technician

Department of Veterans Affairs
Asheville, NC
03.2023 - 04.2024
  • Verifying Insurance Coverage check insurance plans and coverage for specific services
  • Submitting Claims prepare and submit claims to insurance companies, ensuring they are accurate and complete
  • Managing Financial Records patient and office records, including financial information and correspondence with insurances.
  • Medical Coding involved in assigning codes for diagnosed, procedures and medical services which are necessary for accurate billing and reimbursement.
  • Ensuring compliance with review records, coding and billing practices to endure compliance with relevant regulations and guidelines.
  • Software skills include: Currently VRAM, CITRIX, and Microsoft Office.

Patient Financial Counselor

Adventhealth
Hendersonville, NC
11.2021 - 03.2023
  • Explained policies, procedures and services to patients.
  • Received patient inquiries or complaints and directed to appropriate medical staff members.
  • Accessed programs and set up correct payment strategies based on patient means and needs.
  • Obtained informed consent and payment documentation from patients and filed in system.
  • Documented patient counters in hospital system and initiated follow-up actions.
  • Counseled patients on potential financial liabilities and payment requirements.

Claims Resolution Specialist

HCA Healthcare Inc.
Asheville, NC
11.2020 - 11.2021
  • Processed payments, refunds and adjustments.
  • Gathered and reviewed rejected claim information in order to develop successful resolutions.
  • Detailed coverage, liability and reasons for denial of claims to policyholders, attorneys and third-party providers.
  • Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
  • Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
  • Planned and conducted investigations of claims to confirm coverage and compensability.

Advanced Medical Support Assistant

Mission Hospital System
Asheville, NC
09.2018 - 11.2021
  • Updated outdated patient information to maintain current records.
  • Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
  • Organized charts, documents and supplies to maintain team productivity.
  • Conducted insurance verification and pre-certification and pre-authorization functions.
  • Secured patient information and maintained patient confidence by completing and safeguarding medical records.

Patient Financial Representative

Blue Ridge Community Health Care
Hendersonville, NC
07.2014 - 09.2018
  • Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
  • Worked closely with delinquent account holders to collect and reconcile accounts through approved channels.
  • Answered customer questions regarding account discrepancies or problems.
  • Contacted insurance companies to check status of claim payments.
  • Received payments and posted amounts to customer accounts.
  • Recorded information about status of collection efforts.

Payment Poster

All-states Medical Supply
Fletcher, NC
07.2014 - 07.2013
  • Downloaded, printed and batched electronic funds transfers and remits.
  • Posted payments and sent reviews and denials.
  • Handled all electronic and manual payments and adjustments, ensuring that data was accurately posted.
  • Reviewed refund requests and forwarded information to analyst.

Medical Claims Adjuster

Sitel
Asheville, NC
07.2008 - 07.2013
  • Inputted data into the system, maintaining accuracy of provider coding information and reported services.
  • Stayed current on HIPAA regulations, benefits claim processing, medical terminology and other procedures.
  • Reviewed administrative guidelines whenever questions arose during processing of claims.
  • Reviewed claims for accuracy before submitting for billing.
  • Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
  • Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
  • Conducted secondary evaluations of original investigations documentation and reports to facilitate smooth resolutions.
  • Discussed current cases and issues in claim committee meetings.
  • Input claim information and payments into company database.

Education

High School Diploma -

Asheville High School
Asheville, NC

Some College -

Asheville Buncombe Technical Community College
Asheville, NC

Skills

  • Information and resource management
  • Database management
  • Quality evaluation
  • Rapport building
  • Patient information collection
  • Verbal and written communication
  • Policy explanation
  • Microsoft Office proficiency
  • Problem resolution
  • Documentation and record-keeping
  • Patient communication
  • Calmness under pressure
  • Empathy and caring attitude
  • Claims verification
  • Attention to detail
  • Word processing skills
  • Benefits explanation
  • Outbound calling techniques
  • Medical terminology knowledge
  • Typing speed of 50 WPM
  • Payment calculation proficiency
  • Conflict resolution strategies

Certification

NHA – National Healthcareer Association, Billing and Coding, 2021

Languages

English
Professional

Timeline

Medical Office Specialist /Surgery Scheduler

Mission Health
04.2024 - Current

Medical Reimbursement Technician

Department of Veterans Affairs
03.2023 - 04.2024

Patient Financial Counselor

Adventhealth
11.2021 - 03.2023

Claims Resolution Specialist

HCA Healthcare Inc.
11.2020 - 11.2021

Advanced Medical Support Assistant

Mission Hospital System
09.2018 - 11.2021

Patient Financial Representative

Blue Ridge Community Health Care
07.2014 - 09.2018

Payment Poster

All-states Medical Supply
07.2014 - 07.2013

Medical Claims Adjuster

Sitel
07.2008 - 07.2013

High School Diploma -

Asheville High School

Some College -

Asheville Buncombe Technical Community College

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