Daja Carter
Charlotte
Summary
A multifaceted skill set of 12+ years in healthcare insurance verification, compliance regulation, and customer success. Expertly handles complaints, inquiries and questions to meet clients needs and correct problems related to patient care. Well-versed in policies, procedures and standards. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.
Overview
10
10
years of professional experience
Work History
Patient Access Specialist
Cencora
05.2024 - Current
- Managed insurance verification and eligibility checks for efficient patient flow.
- Assists with a variety of scheduled and unscheduled projects occurring in the department at any given time.
- Participate in product and disease training sessions, internal as well as client-driven;
- Liaise with HCPs for prescription renewals via phone calls
- Manage inbound and outbound calls
- Handling faxes (incoming/outgoing) accordingly and timely
- Coordinated the scheduling of appointments, optimizing provider availability and patient convenience.
- Trained new staff on operational procedures and software systems to enhance team performance.
- Review, Analyze and Report Adverse Events
- Audits and maintains various reports specific to his/her business location by checking for errors, inconsistencies or discrepancies; makes corrections and notifies appropriate personnel of any modifications.
Insurance Claims Representative
Aston Carter
Charlotte, NC
11.2022 - 06.2023
- Verified patient eligibility for insurance coverage by contacting insurance carriers.
- Remains knowledgeable in all federal state laws regarding Compliance and "Meaningful Use" guidelines defined by Center for of insurance plans, including Medicare and Medicaid services.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Conducted regular audits of patient accounts for accuracy of demographic data.
- Work as quality assurance with clients patient billing and claim inventories.
- Contacts insurance companies to obtain missing information, explain and resolve under payments and arrange for payment or adjustment processing on behalf of hospital clients
Administrative Assistant
Employee Practices Counsel
Charlotte, NC
08.2019 - 08.2021
- Collect drug specimen follow and comply with clients’ drug-testing programs and protocol
- Managed incoming calls while providing information or transferring callers to appropriate personnel.
- Supervises and trains new part time employees
- Organized and maintained filing systems for physical and electronic documents, ensuring accuracy and confidentiality of records.
- Composed letters, memos, reports, emails, presentations and other written correspondence as required by management staff.
- Entered data into spreadsheets using Microsoft Excel or other similar programs.
Patient Access Representative
Charlotte Surgery Center
Charlotte, NC
08.2019 - 07.2020
- Verifies patient eligibility and benefits, Identifies and resolves claims/eligibility issues, Complete prior authorization research
- Reviews accuracy of all data and ensures that all claims submitted to government and private payers comply with applicable federal and state regulations.
- Served as a liaison for correspondence between medical staff and third party affiliates.
- Scanned documents into electronic medical records system.
- Maintained confidentiality of all patient information in accordance with HIPAA regulations.
- Created new patient accounts in EMR system as needed.
Site Coordinator
AmerisourceBergen
Fort Mill, SC
03.2016 - 08.2019
- Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program
- Maintains frequent phone contact with provider representatives, third party representatives, pharmacy staff and case managers
- Assist with training with new hires, provide orientation, assign workflows
- Follow up with provider sites, and patient with coverage and information received from medical payers,
- Reviews accuracy of all data and ensures that all claims submitted to government and private payers comply with applicable federal and state regulations
- Audited prescription claims for accuracy of eligibility, supporting documentation, billing and coding
Education
Certified Medical Assistant Program -
Kings College
06-2010
Hopewell High School
06-2009
Skills
- Quality Assurance
- Problem-Solving
- Customer Service
- Detail Oriented
- Training Coordination
- Insurance Verification
- HIPAA Compliance
- Multitasking and Organization
- Medical Terminology
- ICD-10
- Data Entry
- Office Administration
- Time Management
- Workforce Management
- Front desk operations
- Documentation accuracy
References
Available Upon Request
Timeline
Patient Access Specialist
Cencora
05.2024 - Current
Insurance Claims Representative
Aston Carter
11.2022 - 06.2023
Administrative Assistant
Employee Practices Counsel
08.2019 - 08.2021
Patient Access Representative
Charlotte Surgery Center
08.2019 - 07.2020
Site Coordinator
AmerisourceBergen
03.2016 - 08.2019
Hopewell High School
Certified Medical Assistant Program -
Kings College