Ebony Carson
O'Fallon,MO
Summary
Detail-oriented healthcare reimbursement professional with over 15 years of experience in navigating complex billing processes and ensuring regulatory compliance. Expertise in optimizing reimbursement strategies, fostering team collaboration, and driving results in fast-paced environments. Recognized for adaptability, effective communication skills, and strong analytical capabilities. Proven track record of managing evolving needs while maintaining accuracy and reliability in all tasks.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Business Analyst II
Centene Corporation
St. Louis, MO
12.2022 - Current
- Executed established auditing processes to ensure compliance with internal and regulatory standards.
- Utilized advanced problem-solving skills to identify and address challenges affecting business operations.
- Evaluated data sets to determine root causes of challenges and advised on appropriate corrective measures.
- Investigated business requirements and operational problems to optimize processes and improve overall efficiency.
- Evaluated operational procedures through in-depth assessments to uncover control gaps and proposed actionable enhancements.
- Conducted comprehensive analysis of business elements to assess factors influencing results.
- Coordinated with various internal departments to assess business requirements and articulate comprehensive project specifications.
- Analyzed supporting documents and performed observations to substantiate audit results.
- Conducted interviews with auditees to collect essential data for audit processes.
- Facilitated communication with audited staff to gather essential information for audits.
- Collaborated with auditors to identify and rectify errors, ensuring data accuracy.
- Developed and implemented audit strategies to allocate essential resources and verify consistency with established audit goals.
- Conducted gap analysis to pinpoint opportunities for enhancement.
- Engaged in team meetings to contribute insights, exchange ideas, and collaboratively tackle challenges.
- Designed and implemented detailed documentation to support effective onboarding and comprehension of updated processes.
Provider Data Management Analyst
Centene Corporation
St. Louis, MO
10.2018 - 12.2022
- Facilitated enrollment of providers and practitioners into provider data management system.
- Updated providers and practitioners regarding claims payment and directory information.
- Analyzed and updated provider data management system to ensure accuracy and compliance with provider requests.
- Executed comprehensive quality service checks on systemic data, ensuring accuracy in claims processing and provider directory information.
- Conducted research and implemented solutions to address identified issues.
- Adapted quickly to changing priorities in high-pressure settings to support operational efficiency.
- Excelled in delivering high-quality results under pressure to meet stringent deadlines.
- Optimized time management strategies to ensure timely completion of all tasks.
Lead Reimbursement Manager
United BioSource Corporation
St. Louis, MO
12.2011 - 10.2018
- Evaluated applicants' qualifications to determine eligibility for program participation.
- Executed verification of patient benefits within established program time frames.
- Managed prior authorization workflow, adhering to regulatory time constraints for timely approvals.
- Clarified and conveyed patient responsibilities in a timely manner to support effective healthcare management.
- Identified and directed patients to relevant special programs based on individual assessments.
- Served as primary liaison for designated groups of prescribers and patients.
- Maintained meticulous records of billing information to prevent delays in patient treatment.
- Engaged with insurance providers to address and rectify claim rejection issues.
- Monitored and recorded potential adverse events to facilitate communication with manufacturer.
- Identified product quality complaints and communicated findings to pharmacist.
- Organized and led regular client meetings to ensure alignment with goals and proactively address barriers.
- Pursued professional development opportunities to enhance skills and promote a culture of continuous learning within the organization.
Insurance Risk Interviewer
Quest Diagnostics
St. Louis, MO
05.2011 - 12.2011
- Conducted telephone interviews with applicants for life insurance, gathering comprehensive medical, financial, and occupational histories.
- Executed scripted inquiries from insurance companies and accurately documented applicant responses verbatim.
- Conducted thorough reviews and edits of interview data to ensure quality assurance standards.
- Exercised professionalism, courtesy, empathy, and customer service expertise to gather all relevant information.
- Demonstrated proficiency in handling various script elements and web-based tools concurrently.
- Implemented quality control measures to maintain high production standards and enhance product reliability.
- Ensured adherence to all safety policies and procedures as specified in Exam One Safety Manual.
Education
High School Diploma -
Saint Louis University
Saint Louis, MOSkills
- Insurance Risk Management
- Benefit Investigation and Prior Authorization
- Claims Assistance and Appeals
- Medicare and Commercial Insurance
- Case Management
- Territory Management
- CRM Software Proficiency
- Patient Assistance
- Provider Reimbursement
- Contracting and Claims
- Root Cause Analysis
- Proficient in Microsoft applications
- Excellent Interpersonal Communication
- Detail-Oriented Documentation Expertise
- Business Process Improvement
Certification
Pharmacy Technician Certificate number: 2012000394
Timeline
Business Analyst II
Centene Corporation
12.2022 - Current
Provider Data Management Analyst
Centene Corporation
10.2018 - 12.2022
Lead Reimbursement Manager
United BioSource Corporation
12.2011 - 10.2018
Insurance Risk Interviewer
Quest Diagnostics
05.2011 - 12.2011
High School Diploma -
Saint Louis University