Carole Larry
Spring Hill,US
Summary
Dedicated and knowledgeable professional seeking a challenging position where I can leverage my extensive experience in health insurance and medical billing to contribute to the success of the company.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Underpayment Recovery Specialist
Revecore Technologies
07.2024 - Current
- Review outstanding, denied, and underpaid claims
- Analyze payment data and documentation to identify discrepancies and potential underpayments
- Evaluate medical provider contracts to ensure proper reimbursement
- Prepare and submit appeals for underpaid claims to the appropriate payers
- Conduct thorough follow-up with payers to ensure timely resolution and reimbursement
- Negotiate with payers to resolve outstanding issues and secure correct payments
- Research, request, and acquire necessary medical records and supporting documentation
- Maintain accurate records of claim status and communication with payers
- Communicate effectively with internal teams and external payers
- Collaborate with other departments to improve revenue cycle management
- Achieved consistent monthly goals by prioritizing tasks according to urgency and impact on overall business objectives.
- Demonstrated expertise in various collections tools, software applications, and reporting systems for maximum productivity.
- Improved client satisfaction through timely communication and resolution of account discrepancies.
Medical Claims Specialist
US Imaging Network
06.2023 - 08.2024
- Manage and process professional claims for a high-volume medical practice, ensuring accuracy and timeliness
- Utilize ICD-10, CPT, and HCPCS codes to ensure accurate billing and coding
- Review and resolve billing discrepancies, including denials and rejections
- Maintain up-to-date knowledge of insurance regulations and healthcare laws
- Run VOBs to help our providers understand the patient's benefits, reduce claim denials, and inform patients about their financial responsibilities upfront costs
- Submitted electronic/paper claims documentation for timely filing.
- Achieved timely reimbursements for clients through keen understanding of insurance company protocols.
- Managed high volume of claims, consistently meeting deadlines without compromising accuracy or quality.
Licensed Medical Insurance Agent
TRANZACT
07.2022 - 05.2023
- Made outbound calls to introduce prospects to the company's health insurance offerings
- Explain various insurance policies, coverage options, premiums, and benefits to clients
- Developed and maintained relationships with over 100 clients, resulting in a 90% customer satisfaction rate and a 20% increase in policy renewals
- Stay updated on changes in insurance regulations, policies, and industry trends
- Ensure compliance with all state and federal regulations related to health insurance
Licensed Medical Insurance Agent
E-TeleQuote
01.2020 - 06.2022
- Made outbound calls to introduce prospects to the company's health insurance offerings
- Assisted clients with billing and other insurance-related matters
- Performed administrative duties, including extensive software skills and strong communication skills
- Prepared and reviewed insurance applications to verify compliance with regulations.
- Maintained high standards of customer service by building relationships with clients.
- Worked closely with other team members to optimize sales strategies and achieve regional goals.
- Cross-sold insurance products to existing clients to reach sales targets.
- Educated clients on the importance of adequate insurance coverage, fostering trust and loyalty among the existing client base.
- Developed comprehensive knowledge of various insurance products, enabling effective recommendations for clients'' unique situations.
- Efficiently managed policy renewals, ensuring timely processing and accurate coverage updates.
- Built relationships with clients using active listening and issue resolution to provide excellent service.
- Determined client needs and financial situations by listening and scheduling fact-finding appointments.
- Facilitated smooth transitions between carriers when needed, minimizing disruptions to client coverage and maintaining positive relationships with all parties involved.
- Maintained accurate records of all transactions, ensuring compliance with company policies and regulatory requirements.
- Utilized CRM software to manage client relationships.
- Achieved top salesperson status by consistently exceeding sales targets through effective client relationship management.
- Negotiated with service providers to offer exclusive deals for clients, adding value to their policies.
Licensed Insurance Agent/Team Lead
Teleperformance
09.2018 - 12.2019
- Established trust with clients through transparent communication regarding policy costs, coverages, exclusions, and endorsements
- Simplified the claims process for clients and ensured prompt resolution and payment of claims
- Developed customized presentations for prospective clients, highlighting relevant products and benefits based on their unique needs
- Achieved high client retention rates by consistently delivering exceptional service and support throughout the policy lifecycle
- Reduced claim disputes by clearly explaining policy provisions to clients at the time of sale and during policy renewals
- Increased agency efficiency by implementing standardized processes for policy administration, data entry, and client communication
- Upsold additional products and services after identifying customer needs and requirements
- Provided coverage option information to assist clients in protecting assets.
- Attended continuing education courses and workshops to gain additional insurance industry knowledge.
- Promoted products and services using upselling and other sales strategies.
- Recommended type and amount of coverage based on analysis of customers' circumstances using persuasive sales techniques.
- Upsold additional products and services after identifying customer needs and requirements.
- Consistently met or exceeded sales targets through diligent prospecting, follow-up, and effective closing strategies.
- Developed sales leads from direct referrals, networking and targeted marketing campaigns.
- Calculated quotes and educated potential clients on insurance options.
- Delivered outstanding first-contact resolution rates when assisting clients with inquiries about premiums or billing issues.
- Improved client satisfaction by providing tailored insurance solutions and exceptional customer service.
- Retained existing clientele by regularly reviewing their policies and recommending adjustments as needed to maintain optimal coverage.
- Finalized sales and collected necessary deposits.
- Negotiated contracts and terms of sale with potential customers.
- Analyzed customer needs to provide customized insurance solutions.
- Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas.
- Met with customers to provide information about available products and policies.
- Analyzed risk factors to recommend appropriate coverage levels.
- Monitored customer feedback and identified areas of improvement.
- Conducted annual reviews of existing policies to update information.
Education
High School -
Marion Franklin High School
Columbus, OH06.2013
No Degree - Medical Billing And Coding Certification
Rasmussen University
Remote05-2026
Bowling Green State University -
Bowling Green State University
Bowling Green, OH05.2014
Skills
- Phone etiquette
- Medical record review
- Thorough claims reviews
- Medicaid knowledge
- Insurance Claim Forms Review
- Insurance claims processing
- Claims Processing
- Insurance Coverage Verification
- Billing Software
- HIPAA knowledge
- Denied claims identification
- EOB Analysis
- Medicare Insurance Agent
- Data Entry
Certification
- Insurance Producer License
- Life Insurance License
- Life & Health Insurance License
Timeline
Underpayment Recovery Specialist
Revecore Technologies
07.2024 - Current
Medical Claims Specialist
US Imaging Network
06.2023 - 08.2024
Licensed Medical Insurance Agent
TRANZACT
07.2022 - 05.2023
Licensed Medical Insurance Agent
E-TeleQuote
01.2020 - 06.2022
Licensed Insurance Agent/Team Lead
Teleperformance
09.2018 - 12.2019
High School -
Marion Franklin High School
No Degree - Medical Billing And Coding Certification
Rasmussen University
Bowling Green State University -
Bowling Green State University
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