GINA R. Carroll
Pontiac,Michigan
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Well regarded for customer service and multi-tasking ability, Excellent oral and written communication as well as great leadership and organizational skills and follow up efficiency. Strong computer knowledge of Microsoft Word, Excel, Access Outlook, Internet and along with various other BCBSM systems. Looking to apply knowledge and abilities to exceptional new role while achieving company goals
Overview
11
11
years of professional experience
Work History
Data Verification Operator
Blue Cross Blue Shield of MI
02.2022 - Current
- Maintains policies and procedures of BCBSM
- The primary function of this position is to input data from optical character recognition information received through image processing using high speed data entry systems
- Receive document images from high speed scanning process compare/verify captured information to the document image using a split screen monitor
- Quality control inspection of images to ensure image clarity
- Keyboard skills of 10,000 net keystrokes per hour with 95% accuracy required
- Ability to quickly analyze data to analyze comparative data to identify discrepancies
- Stayed on top of daily workload with speed and efficiency.
Medical Information Specialist
Blue Care Network 20500 Civic Center Dr
02.2020 - 02.2022
- Provide analysis and investigation of authorization requests for medical, surgical and outpatient procedures
- Provide information and assistance pertaining to medical management program to providers and hospitals and members
- Collect and record appropriate data in order to issue authorization and route request for services that require medical review to appropriate team members
- Facilitate communication with providers regarding status on authorizations and referrals
- Identify relevant issues and route to appropriate department for action and resolution
- Maintained knowledge of policies and procedures for accurate resolution for grievance and appeals
Asst. Office Operations
Ascension Medical Group
01.2019 - 02.2020
- Verifies and enters demographic information
- Reconciling reports for accuracy
- Provides support for population and health team
- Retrieves and reviews health plans gaps in care and corrects discrepancies
- Running various population health reports and manipulating data
- Collected, recorded and analyzed data related to nursing care of patients.
- Analyzed information systems and applications to identify specifications for implementation projects.
- Analyzed and interpreted patient, nursing or information systems data to improve care.
Payment Posting Representative
Trinity Health
07.2018 - 12.2018
- Performing cash transactions and posting and balances, records and prepares bank deposits in a timely manner
- Uses Health quest software to calculate the patient insurance and balances when posting payments and denials
- Posts insurance denials with associated reasons for insurance remittance advices for follow up by disputed claim staff
- Edits and ensures all data is received and processed correctly
- Researches and resolves unapplied cash and misapplied payment requests.
- Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
Medical Coding Analyst
Strategic Staffing, Blue Care Network, Center Dr
01.2018 - 05.2018
- Coordinates and preparation management of the annual HEDIS medical record review
- Requesting records and performing follow up requests within the HEDIS Database
- Assisting manager with ongoing client and provider reviews
- Communicates project status on a weekly basis for the quality and population health department
- Performing provider outreach duties
- Conducting claims and coding research on various members
- Work with data analysts to develop and optimize data reports and patient line lists for office staff
Hedis Project Coordinator
Molina Healthcare
10.2014 - 09.2017
- Use of HEDIS software for data entry and QA queries
- Reviews medical records to ensure standard are met by NCQA, Molina and auditor
- Organizational skills with the ability to handle multiple tasks and /or projects at one time
- Customer service skills with the ability to interact professionally and effectively with providers, physicians, corporate and staff from all departments with and outside Molina Healthcare
- Assists with project plans as appropriate to meet changing needs and requirements as needed
- Batch uploading HEDIS, RA and SDCT records to corporate through the CMCM network
- Running various reports in CMCM for various projects
- Paying and keeping of track of medical record invoices.
Collections Document Reviewer
American Red Cross
11.2013 - 10.2014
- Reviewing blood donor records for collected and deferred donors for accuracy and completeness
- Provide information to appropriate American Red Cross departments to quarantine, destroy, or release blood products
- Consult with management as needed regarding disposition of products and or questionable blood donor records and documentation
- Provide complete and accurate documentation on all paperwork, including blood donor records, donor status, change records and component status
- Contact staff as necessary to resolve issues, questions or omissions on reviewed paperwork.
Quality Assurance/ Manager
DRS SERVICES INC
04.2013 - 10.2013
- Physician Credentialing
- Auditing physician notes for Medicare compliance
- Coding E/M Visits
- Reviewing quality assurance standards
- Writing quality assurance policies and procedures
- Assisting physicians with education of documentation requirements for Medicare compliance
- Writing reports of statistical data summarizing quality assurance findings and
- Providing feedback on performance
- Analyze and implemented compliance procedures
Education
Bachelors of Science Degree - Health Administration
University of Phoenix
Troy, MI06.2008
Skills
- HIPAA Training
- Coding/Billing
- Knowledge of Blue Cross Systems and Operations
- ICD-9 and CPT Coding
- Reviewing and Analyzing Claims
- DRG & APG Assignments
- HIPAA Regulations/Medicare Guidelines
- Medical, Pharmacology and Anatomy Physiology Terminology
- Project Management
- Clinical Data Analysis and Extraction
- Managed Care Regulations/JCAHO Guidelines
- Data Management
- Organizational Skills
- Decision Making
- Proofreading and Editing
- Insurance Claim Forms Review
- License Verification
- Licensing Regulations
- Compliance Oversight
Timeline
Data Verification Operator
Blue Cross Blue Shield of MI
02.2022 - Current
Medical Information Specialist
Blue Care Network 20500 Civic Center Dr
02.2020 - 02.2022
Asst. Office Operations
Ascension Medical Group
01.2019 - 02.2020
Payment Posting Representative
Trinity Health
07.2018 - 12.2018
Medical Coding Analyst
Strategic Staffing, Blue Care Network, Center Dr
01.2018 - 05.2018
Hedis Project Coordinator
Molina Healthcare
10.2014 - 09.2017
Collections Document Reviewer
American Red Cross
11.2013 - 10.2014
Quality Assurance/ Manager
DRS SERVICES INC
04.2013 - 10.2013
Bachelors of Science Degree - Health Administration
University of Phoenix
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