CRANEISHA CARMICHAEL TUTEN

LEADING EDGE ADMINISTRATORS
12/27/2022 - CURRENT
CUSTOMER SERVICE REPRESENTATIVE
● SERVICE HIGH VOLUME INBOUND CALLS 30-85 CALLS PER DAY, ADMINISTER OUTBOUND CALLS DAILY,
ESCALATE AND DE-ESCALATE CALLS
● SPEAK WITH PROVIDERS AND MEMBERS REVIEWING MEDICAL BENEFITS FOR DIFFERENT HEALTH PLANS,
MEDICAL CLAIMS, MEDICAL RECORDS REVIEW, AND STATUS, APPEAL REVIEW AND STATUS CONFIRM
PAYMENTS AND DENIALS O CLAIMS
● SEND CLAIMS TO REPROCESSING WHEN THERE IS A DISCREPANCY, OR A CLAIM PROCESSED INCORRECTLY.
SENDS EMAILS ON BEHALF OF MEMBERS OR PROVIDERS TO THE CORRECT SERVICE EMAIL ADDRESS. CONFIRM
PRECERTIFICATION NEEDS, SUBMIT CHECK TRACERS AND PAY BATCH REQUESTS
● BEEN PLACED IN THE LEA SPOTLIGHT, AND HAVE NUMEROUS OF RECOGNITIONS AND HIGHLIGHTS FROM
SUPERVISORS, TEAM LEADS AND MY PEERS
● SENDS COCC LETTERS, ID CARDS, PHI FORMS, HEALTH INSURANCE PACKETS, INJURY QUESTIONNAIRE
FORMS WHEN NEEDED
● NOTATE ALL ACCOUNTS I HANDLED AND REVIEWED.

• SERVICE HIGH VOLUME INBOUND CALLS 20-70 CALLS PER DAY, ADMINISTER OUTBOUND CALLS DAILY
• ESCALATE AND DE-ESCALATE CALLS
• SPEAK WITH PROVIDERS AND MEMBERS REVIEWING MEDICAL BENEFITS FOR DIFFERENT HEALTH PLANS
• MEDICAL CLAIMS, MEDICAL RECORDS REVIEW AND STATUS, APPEAL REVIEW AND STATUS, CONFIRM
• PAYMENTS AND DENIALS ON CLAIMS
• SEND CLAIMS TO REPROCESSING WHEN THERE IS A DISCREPANCY, A CLAIM PROCESSED INCORRECTLY
• SENDS EMAILS ON BEHALF OF MEMBERS OR PROVIDERS TO CORRECT SERVICE EMAIL ADDRESS
• CONFIRM
• PRECERTIFICATION NEEDS, SUBMIT CHECK TRACERS AND PAY BATCH REQUESTS
• BEEN PLACED IN THE LEA SPOTLIGHT , HAVE NUMEROUS OF RECOGNITIONS AND HIGHLIGHTS FROM
• SUPERVISORS, TEAM LEADS AND MY PEERS
• SENDS COCC LETTERS, ID CARDS, PHI FORMS, HEALTH INSURANCE PACKETS, INJURY QUESTIONNAIRE
• FORMS WHEN NEEDED
• NOTATE ALL ACCOUNTS I HANDLED AND REVIEWED., LICENSED 20-44
• MAINTAIN CUSTOMER SATISFACTION, TAKE HIGH VOLUME INBOUND CALLS (80-150 CALLS PER DAY)
• EXPLAIN BILLS AND POLICIES TO CUSTOMER, NOTATE / TYPE THE ACCOUNT FULLY, ADJUST BILLS AND
• SCHEDULE PAYMENTS FOR CUSTOMERS, DELAY PAYMENTS
• UPDATE MORTGAGE HOLDER INFORMATION, SEND OUT ID CARDS AND DECLARATION PAGES, PLACE CUSTOMERS
• ON DIFFERENT BILLING METHODS
• CHANGE CUSTOMERS PLANS UNDER COMPANY GUIDELINES AND POLICIES
• RE-ROUTE CALLS IF NECESSARY

Medical Biller
● Created the initial claim, billed out, and mailed or electronically submitted these claims to
PIP auto insurance companies or Health insurance companies.
● Verified insurance, claim numbers and policy numbers as well as policyholders and
Attorneys for patients.
● Small data entry for new accounts and or new patients, scanned in paper work through
scandox, and printed reports through PACS system, and Abbadox system.
● Printed HCFA’s daily, and distributed stacks or piles of HCFA’s to each designated insurance
company.
● Made adjustments and write off’s to each patient account if necessary.

• ANSWERED PHONE CALLS AND QUESTIONS ABOUT THE FACILITY
• SCHEDULED/RESCHEDULED APPOINTMENTS
• CHECK PATIENTS IN AND OUT
• PROCESSED PAYMENTS
• PREPPED DOCTORS AREA AND SURGERY EQUIPMENT, STERILIZED INSTRUMENTS
• ASSISTED WITH DRESSING PATIENTS UNDER SEDATION AND REVERSED MEDICINES
• MEDICINE HANDLER
• VERIFIED INSURANCE COVERAGE FROM INSURANCE CARRIERS/ CO-PAYMENTS / IN AND OUT OF NETWORK
• COVERAGE
• MEDICAL BILL AND CODED FOR EACH OFFICE VISIT

• Responsible for authorization requests and denied or approved matters for the patients claims
• Works from excel spreadsheets and calculations daily from medical releases of financial equipment for patients accounts that’s in Acis
• Communicates effectively with commercial insurance carriers to ensure appropriate action is demonstrated in a timely manner
• Works with all patient medical billing matters with primary and secondary payers to assure expedited and accurate claim processing
• Concorde Career Institute 1/20

• Created the initial claim, billed out and mailed or electronically submitted these claims to
• PIP auto insurance companies or Health insurance companies
• Verified insurance, claim numbers and policy numbers as well as policy holders and
• Attorneys for patients
• Small data entry for new accounts and or new patients, scanned in paper work through scandox, and printed reports through PACS system, and Abbadox system
• Printed HCFA’s daily, distribute stacks or piles of HCFA’s to each designated insurance company
• Made adjustments and write off’s to each patient account if necessary.

• Responsible for billing tasks such as data entry, resolving patient inquiries and knowledge of third party carriers
• Regularly works all patient medical billing matters with primary and secondary payers and patients to assure expedited and accurate claim processing
• Initiates audits of patient accounts or unpaid claims to ensure collection of payment
• Researches and resolves delinquent accounts and arranges mutually agreeable payment schedules
• Communicates effectively with commercial insurance carriers to ensure appropriate action is demonstrated in a timely manner
• Responds to patient insurance inquiries promptly and refer them to the appropriate department or person when necessary
• Documents patient account communication and/or follow-up in the billing/collector system appropriately
• Promote and maintain positive relationships both internally and externally
• Maintain confidentiality, in accordance with HIPPA regulations and company policy, with patients and commercial insurance carriers regarding sensitive data
• Competent in Medical Billing software, Microsoft Office, and related computer programs to maintain records and files for all transactions

• Delivered patient care companionship/safety, bathing assistance, dressing assistance, grooming, medication reminders, light housekeeping, meal preparation