Carol Edler
Norfolk,Va.
Summary
Use experience gained after 10 years of Army active duty service overseas in Germany, Korea and stateside to include Alaska in Telecommunication both communication center/tactical and the leadership.
Overview
22
22
years of professional experience
Work History
ECOB SPECIALIST II REMOTE
Anthem/Elevance
Norfolk, VA
01.2019 - 01.2024
- Coordination of benefits by using CAQH, avalitity and several commercial portals for primary payer on WGS, NASCO
- Medicare Secondary payer worked Medicare demands (refund request)and treasury accounts for employers
- Keyed claims both UB and 1500 that were billed to Medicare when commercial was the primary payer
- Completed eligibility forms submitted to the employer
- Completed refund request to Medicare, Providers, treasury, Medicaid and commercial insurances.
INSURANCE/BILLING SPECIALIST
Atlantic Anesthesia
Virginia Beach, VA
01.2016 - 01.2017
- Patient scheduling, acquired preauth acquired prescriptions set referrals prepared for next business day.
INSURANCE/BILLING SPECIALIST
The Up Center
Norfolk, VA
01.2014 - 01.2016
- Post payments from Insurance and Government agencies
- Completed invoices for EAP, Workers Comp
- Credentialing for LCSW, LPC for all commercial insurance, Medicare, Medicaid and Tricare under new guidelines
- Implemented billing of claims using insurance web portals, trained billing staff on submission and regulations for government/commercial insurance
- Trained clinical staff on documentation regulation for EAP, Outpatient, Therapeutic consulting
- Reconciled payroll for Outpatient Clinicians
- Reviewed insurance contracts to ensure the needs of the clinical services
- Reviewed Foster Care contracts.
Patient Care Specialist
Medical Equipment Distributors
Virginia Beach, VA
04.2013 - 05.2014
- Workers Comp documentation informed Doctors what the guidelines were for all Commercial insurance as well as Medicare/Medicaid
- Wrote and submitted Redetermination, Reconsideration, and Administration Law Judge Appeals
- Reviewed Medical records, also sent Medical records CMN's to Tricare North, South, and West region
- The resolved the insurance issues pre-existing condition, family changes
- Reviewed documents for HIPPA compliance documents, physician orders, and Medical records
- Durable Medical
- Set up payment plans for patients
- Sold transport chairs, scooters retail.
PBS Analyst
MD Anderson Cancer Center
Houston, TX
08.2008 - 05.2011
- Reviewed documentation to support cancer treatment for both standard and experimental treatment
- Worked with employers benefit (HR) department to acquire approval for treatment (stem cell) transplants for preexisting employees/sponsored family, Trained hospital councilors on regulations and guidelines for Traditional Medicaid, Evercare, Chips, PCCM, AMERIGROUP, Texas Children's Acquired retro auth's, Medical appeals for Medicare and Medicaid, Managed care, Medicaid online, Evercare via UnitedHealth care, submitted state appeals with patient records supporting ICD and Procedure code to HHS Texas
- Acquired authorizations for patient's admissions, services.
DME Specialist
Bargman Management
Akron, OH
02.2006 - 05.2008
- Billing and collection of Durable Medical Equipment Billing of Patients balances and collections for several DME companies in Ohio, New York, Kentucky, Tennessee, Texas
- Worked on several programs
- Assisted patients with acquiring secondary insurance, transferring from commercial to Medicare.
Medical Biller
15W PHARMACY
Edison, NJ
06.2002 - 05.2005
- Set up the billing system for coding and pricing of pharmaceuticals for Nursing Home facility's for Medicaid, Medicare acquired Authorizations for ICD-9 to CPT supported pharmaceuticals Implemented the Durable Medical Equipment billing program Tamarac.
Education
TACTICAL TELECOMMUNICATIONS OPERATOR -
United States Army Reserves
TACTICAL TELECOMMUNICATIONS OPERATOR -
United States Army - Attended Fort Gordon Signal School
Respiratory Therapy
Youngstown State University
Youngstown, OHSouth High School
Skills
- Customer Relations
- Expert Problem Solving
- Documentation Management
- Quality Assurance
- Proficient in Software
- Supply Management
- Problem-Solving
- Multitasking
- Attention to Detail
- Multitasking Abilities
- Written Communication
- Relationship Building
- Reliability
- Problem-solving aptitude
- Team Collaboration
- Adaptability and Flexibility
- Adaptability
- Professional Demeanor
Phone
757-622-1969, 848-250-1796
Training
Training along with the 20+ years of experience in customer services fields of insurance, training new hires on several billing systems Med ISOFT, Medical Management, Lauris, WRSHealth and MEDITouch. Implemented training sessions for both clinicians/ management. Implemented training for patients in acquiring social security disability, Medicare, Medicaid and all Commercial Insurances. Working with all insurances both commercial and government. Set up and trained staff on 827/direct data portals.
Timeline
ECOB SPECIALIST II REMOTE
Anthem/Elevance
01.2019 - 01.2024
INSURANCE/BILLING SPECIALIST
Atlantic Anesthesia
01.2016 - 01.2017
INSURANCE/BILLING SPECIALIST
The Up Center
01.2014 - 01.2016
Patient Care Specialist
Medical Equipment Distributors
04.2013 - 05.2014
PBS Analyst
MD Anderson Cancer Center
08.2008 - 05.2011
DME Specialist
Bargman Management
02.2006 - 05.2008
Medical Biller
15W PHARMACY
06.2002 - 05.2005
TACTICAL TELECOMMUNICATIONS OPERATOR -
United States Army Reserves
TACTICAL TELECOMMUNICATIONS OPERATOR -
United States Army - Attended Fort Gordon Signal School
Respiratory Therapy
Youngstown State University
South High School