CARTER NIKITA
CINCINNATI,OH
Summary
Provide exceptional and enthusiastic customer service with a high attention to detail. Quick learner and talented at developing, growing and maintaining relationships. The ability to work effectively in a team setting.
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Overview
24
24
years of professional experience
1
1
Certification
Work History
INSURANCE OPERATIONS
WESTERN & SOUTHERN FINANCIAL GROUP
Cincinnati, OH
06.2022 - Current
- Generated, posted and attached information to claim files.
- Checked documentation for accuracy and validity on updated systems.
- Carried out administrative tasks by communicating with clients and scanning documents.
- Maintained confidentiality of client finances, records, and policy information.
- Handled incoming phone calls regarding payments, policy changes along with sending special request.
AGENT SCHEDULING
Cincinnati Children’s Hospital
Cincinnati, OH
01.2016 - 05.2022
- Schedule, Reschedule and confirm appointment dates for patients
- Coordinate appointments with other departments
- Provider appointment preparations and directions as needed
- Aid with scheduling proper test from orders placed by physicians
AMBULATORY FOLLOW UP SPECIALIST
Magellan Behavioral Health
Cincinnati, OH
01.2011 - 12.2015
- Schedule and confirm appointment dates for customers
- Assist patients discharged from inpatient care engage in appropriate outpatient services by referring member to the appropriate level of care
- Communicate timely and permissible information regarding discharge information of clients with inpatient facilities, outpatient providers and internal clinical team.
CUSTOMER SERVICE SPECIALIST
Magellan Behavioral Health
Cincinnati, OH
05.2007 - 01.2011
- Began prior authorization process for mental health
- Identified and responded to crisis calls
- Reviewed Insurance policy to determine coverage and provided members with a providers list as needed
UTILIZATION MANGEMENT
Anthem Blue Cross/Blue Shield
Cincinnati, OH
01.2002 - 03.2006
- Managed medical policies
- Gathered Clinical information to authorize medical procedures
- Utilized medical terminology and problem solving
- Organized paper and electronic filing systems, recorded information, updated and maintained documents, such as correspondence along with other material
- Completed forms in accordance to company procedures
- Obtained authorizations from multiple insurance carriers for various levels of care.
Education
Business Administration
Western Governors University
Salt Lake City, UT03.2024
N/A -
University of Cincinnati Blue Ash College
Cincinnati, OH01.2021
Skills
- Organizational Skills
- Dependable and Responsible
- Multitasking Abilities
- Problem-Solving
- Analytical and Critical Thinking
- Strong Attention to Detail
- Teambuilding
- Cultural Awareness
- Teamwork and Collaboration
Certification
PSM I- Professional Scrum Master
Timeline
INSURANCE OPERATIONS
WESTERN & SOUTHERN FINANCIAL GROUP
06.2022 - Current
AGENT SCHEDULING
Cincinnati Children’s Hospital
01.2016 - 05.2022
AMBULATORY FOLLOW UP SPECIALIST
Magellan Behavioral Health
01.2011 - 12.2015
CUSTOMER SERVICE SPECIALIST
Magellan Behavioral Health
05.2007 - 01.2011
UTILIZATION MANGEMENT
Anthem Blue Cross/Blue Shield
01.2002 - 03.2006
Business Administration
Western Governors University
N/A -
University of Cincinnati Blue Ash College