Corrisa McCarter
Houston,TX
Summary
Health Information Professional experienced in clinical documentation, medical records management, and HIPAA compliance. Delivered effective care coordination by managing electronic health records and ensuring timely data compilation. Facilitated communication and managed referrals to support regulatory compliance within healthcare environments.
Overview
16
16
years of professional experience
Work History
Claims Representative
UnitedHealth Group
Houston, TX
07.2025 - Current
- Process a high volume of medical, hospital, and pharmacy claims through automated and manual review workflows. Verify patient eligibility, plan benefits, and coverage rules using payer systems and internal databases.
- Review and validate ICD-10, CPT, and HCPCS codes for accuracy and appropriate billing. Evaluate claims for potential payment, denial, or adjustment based on policy provisions and medical necessity.
- Identified and corrected claim discrepancies such as missing information, coding errors, and invalid provider details to ensure accurate claims processing.
- Managed incoming documentation through email, electronic submissions, and secure worklists to support timely claims evaluation.
Clinical Admin Coordinator
UnitedHealth Group
Houston , TX
02.2022 - 07.2025
- Manage and maintain comprehensive EHR and documentation, ensuring 100% adherence to regulatory requirements, HIPAA standards, and internal data governance policies.
- Identified and remediated documentation discrepancies, including missing clinical elements, coding errors, or invalid provider data, ensuring accuracy of Master Patient Index (MPI) and billing databases.
- Facilitated secure communication and data exchange between patients, physicians, and multidisciplinary healthcare teams, enhancing care coordination and informed clinical decision-making.
- Provided administrative oversight to Central Support team, utilizing secure electronic worklists and EMR workflows to streamline health information lifecycle.
- Serve as a subject matter expert on patient confidentiality and HIPAA, resolving routine inquiries, and escalating complex privacy or documentation issues to ensure total compliance
Medical Records Retrieval Specialist
Maximus VES
10.2018 - 02.2022
- Initiated and managed 80+ calls per shift to provider offices and healthcare facilities, securing medical records for claims and authorization reviews.
- Verified provider contact details and required documentation, ensuring accuracy of clinical notes, lab results, imaging reports, and physician signatures.
- Review incoming records for completeness and ensure they meet payer and compliance documentation standards. Accurately index, upload, and attach medical records into EMR/EHR and case management systems.
- Followed up on pending requests, ensuring timely turnaround within SLA requirements to maintain workflow efficiency.
Insurance Verifier
Memorial Village ER
11.2015 - 10.2018
- Manage high volume inbound and outbound calls to verify patient insurance coverage, eligibility, and benefit details for upcoming services.
- Confirmed patients’ copays, coinsurance, deductibles, coverage limitations, and out-of-pocket costs with insurance carriers, validating policy status, plan effective dates, and referral or authorization requirements to ensure accurate billing.
- Performed real-time verification through multiple payer portals including Medicare, Medicaid, and commercial carriers, enhancing accuracy of patient insurance information.
- Reviewed CPT, ICD-10, and HCPCS codes for alignment with payer coverage guidelines, identifying and resolving discrepancies in insurance data to maintain compliance and minimize claim denials.
Prior Authorization Specialist
Creation Living Center
11.2010 - 11.2015
- Managed high-volume inbound and outbound calls to verify insurance coverage and secure prior authorizations for medical services, diagnostic tests, and prescriptions, ensuring timely patient care.
- Collaborated with physicians, clinical staff, and schedulers to gather essential documentation, including medical necessity and referral information, streamlining authorization processes.
- Maintained accurate insurance information, authorization numbers, and patient demographics in EMR/EHR and billing systems, supporting efficient claims processing.
- Interpreted EOBs, payer guidelines, and policy requirements to resolve coverage issues, denials, or authorization rejections.
Education
Certificate - Medical Administrative Assistant
College Oh Healthcare Professions
Houston, TX04-2022
High School Diploma -
Taylor High School
Houston, TX06-2010
Bachelor of Science - Health Information Management
Southern New Hampshire University
(in Progress)09-2026
Skills
- CPT, CDT, ICD-10, HCPCS Codes
- Claims processing
- Customer Service
- Denial management
- Electronic health records
- Eligibility & Medical Information Verification
- EOB interpretation
- Epic, Salesforce, Athena
- Insurance Verification
- Medical Coding
- Medical Records Retrieval & Release of Information (ROI)
- Record Request Processing
- Regulatory Compliance
- Revenue cycle management
- Prior Authorization Processing
Timeline
Claims Representative
UnitedHealth Group
07.2025 - Current
Clinical Admin Coordinator
UnitedHealth Group
02.2022 - 07.2025
Medical Records Retrieval Specialist
Maximus VES
10.2018 - 02.2022
Insurance Verifier
Memorial Village ER
11.2015 - 10.2018
Prior Authorization Specialist
Creation Living Center
11.2010 - 11.2015
Certificate - Medical Administrative Assistant
College Oh Healthcare Professions
High School Diploma -
Taylor High School
Bachelor of Science - Health Information Management
Southern New Hampshire University