Che'Ynise Carter
McKinney,TX
Summary
Goal-oriented professional with expertise in enhancing operational standards and team organization. Proven ability to implement effective employee engagement strategies that drive productivity. Strong analytical skills utilized to streamline processes and prioritize tasks efficiently. Extensive experience with a demonstrated history of achieving measurable results.
Overview
8
8
years of professional experience
Work History
Provider Data Analyst
Blue Cross Blue Shield Texas
Richardson, Texas
08.2024 - Current
- Collecting and Interpreting Provider Data as Required
- Performing Geo access Reporting and establishing schedules to collect and interpret data
- Providing Rosters for Providers to bill their claims
- Credentialing Providers For billing
- Corresponding with Providers via email regarding their request
- Handling 10/20 cases a day depending upon volume
Sr. Disability Specialist
Sedgwick
Chicago, Illinois
06.2022 - 05.2024
- Analyze, approve and authorize assigned claims. Determine benefits due pursuant to the disability plan
- Independently managed a caseload and made claims decisions on, moderately complex claims which consists of pending, ongoing, and appeal reviews.
- Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination.
- Review and analyze complex medical information such as Diagnostic testing, Office Visit Notes, and Operative Reports to determine if the claimant is disabled.
Sr. Provider Data Maintenance
Blue Cross Blue Shield
Chicago, Illinois
08.2020 - 12.2020
- Responsible for the analyzing, researching, and applying business rules to complete requests received from providers
- Strong interpersonal skills with the ability to engage effectively with management, staff, and clients
- Review contracting, create Salesforce CRM, credentialing and maintenance of Provider Data to support Claims payment, Marketing, Membership and Network Contracting across all lines of business.
- Identified missing information on providers account and update the case accordingly
- Identify Network Contracting, Enterprise Credentialing, Claims Processing and Product Development, Special Investigations Department, Legal, Marketing, Full Service Units, ITG, Government Programs, Social Security and other business partners on network activities.
HEDIS Admin
Blue Cross Blue Shield
Chicago, Illinois
01.2020 - 04.2020
- Provide timely FEP HEDIS measure status reporting, including trending and analyzing of the data
- Contacted provider offices to identify the physical location of charts and complete measures
- Perform clerical functions to include; medical record request, faxing and calls to members and providers as needed.
- Maintain organized, updated reporting of activities with clear documentation.
- Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports.
- Provide support to assess and analyze available information from internal and external data, and other sources as needed.
Billing Consultant
Have a Heart Homemaker SVC
Chicago Heights, Illinois
09.2019 - 01.2020
- Call Insurance providers regarding denials
- Manage Status of Accounts
- Identify Insurance Coverage
- Gain Prior Authorizations from In network insurance companies
- Furnishes precise and correct records and billing data on the computer
- Create billing portals for insurance providers
- Completes billing information and records in the computer system by ensuring that the data is correct and appropriate.
- Documenting Service Interruptions and Resumptions
- Operating Microsoft Excel and Word Applications for Data Purpose
Lead Patient Access Representative
Advocate Christ Medical Center
Oak Lawn, Illinois
11.2017 - 08.2019
- Guides the front office team to better business outcomes. Leadership duties include focusing on the constant improvement of customer service, process efficiency and effectiveness, lowering error rates, improving TOS payments, improving precertification speed and accuracy, and establishing daily protocols.
- Checks in/out patients at time of visit.
- Answers phones in a timely manner and in accordance with company policy.
- Schedules patient visits per organizational standards.
- Responsible for obtaining and verifying all demographic and insurance information.
- Verifies all insurance demographics and coverage by using online, or phone resources of the insurance company. Position understands that the only acceptable goal is 100% verification of all insurance Demographics and coverage prior to the patient setting foot in our facility.
Education
Bachelors of Science - Healthcare Management
University Of Phoenix
Phoenix, Arizona04.2023
General Studies -
Chicago High School For The Arts
Chicago, Illinois06.2015
Skills
- Communication
- Claims processing
- Medical record analysis
- Healthcare industry
- Data validation
- HIPAA compliance
- Excel mastery
- Microsoft Access
- Verbal and written communication
- Leadership
- Customer Service
- Flexibility
- Technology
Awards
- Customer Service Award
- Highest Deductible Collector Award
Languages
English
References
References available upon request.
Timeline
Provider Data Analyst
Blue Cross Blue Shield Texas
08.2024 - Current
Sr. Disability Specialist
Sedgwick
06.2022 - 05.2024
Sr. Provider Data Maintenance
Blue Cross Blue Shield
08.2020 - 12.2020
HEDIS Admin
Blue Cross Blue Shield
01.2020 - 04.2020
Billing Consultant
Have a Heart Homemaker SVC
09.2019 - 01.2020
Lead Patient Access Representative
Advocate Christ Medical Center
11.2017 - 08.2019
Bachelors of Science - Healthcare Management
University Of Phoenix
General Studies -
Chicago High School For The Arts