Summary
Overview
Work History
Education
Skills
Accomplishments
References
Timeline
Generic

KARA CHAPLIN

Ellicott City,MD

Summary

Experienced healthcare administration professional with a strong foundation in management and over 5 years of diverse office setting experience. Proficient in medical terminology, HMOs, PPOs, Medicare, CPT coding, and insurance billing. Skilled in insurance verification, prior authorization, billing, claims/appeals, records management, and providing exceptional customer service. Successfully handled claims and billing follow-up with commercial, managed care, and government insurance. Motivated employee with a proven track record of driving revenue and maintaining operational integrity in multiple retail locations specializing in the wireless industry. Committed to delivering outstanding service, exceeding employer expectations, and fostering long-term customer loyalty. Demonstrates exceptional interpersonal and team building skills, with an ability to build rapport with a diverse range of customers, managers, and colleagues.

Overview

27
27
years of professional experience

Work History

Commitment Record Specialist II

State Of Maryland
01.2023 - Current

Maintain commitment records and files on inmates using information from court records, local detention center records, and other criminal justice databases.

  • Adjust calculation of time inmate’s serve through awarding or retracting of various credits (good conduct, industrial assignments, educational assignments, special projects, housing location granted by the DOC and state or local jurisdictions.
  • Create legal memos dependent on the inmate sentence or parole eligibility and/or the reason for denial.
  • Ensure COMAR regulations-Annotated Code and State appellate decisions to identify and follow procedures for documenting and
    calculating inmate sentences.
  • Communicates the calculation of inmate prison
    sentences/inmate release dates to judges, attorneys,
    parole officers, coworkers, inmates and their families.
  • Prepare written summaries of inmates’ time credits and writs/summons that accompany inmates to court appearances
  • Prepare and examine forms and letters notifying other
    jurisdictions, State officials, families of the victims, and
    others regarding the planned time and place of an inmate's release
  • Participates in ongoing training-changes in laws,
    regulations, policies, and court orders that affect the
    calculation of inmate sentences
  • Prepare reports/correspondence for the signature of the Warden/Assistant Warden pertaining to the calculation of sentences/release for inmates

Insurance Coordinator

Advanced Surgery Center
03.2022 - 01.2023
  • Enhanced claim processing efficiency by verifying insurance coverage and benefits for patients.
  • Reduced discrepancies in billing by consistently obtaining accurate patient information and documentation.
  • Expedited claim approvals with thorough pre-authorization submissions and diligent followups.
  • Improved patient satisfaction rates by providing clear explanations of benefits, coverage, and billing procedures.
  • Place phone calls to patients, patient’s family, insurance companies, and facility personnel in an attempt to acquire information necessary to verify active coverage.
  • Maintains patient demographic information and data collection systems.
  • Verify insurance eligibility for upcoming appointments by utilizing online websites or by contacting the carriers directly.
  • Review patient deductibles and/or copays and enter into the billing system provided for all front end staff at all locations.
  • Assist front end staff and call center staff in understanding carrier websites and verification of eligibility.
  • Answers questions from patients, clerical staff and insurance companies.
  • Performs miscellaneous job-related duties as assigned.
  • Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

Scheduling Coordinator

Elizabeth Cooney Care Network
01.2021 - 02.2022
  • Gathered employee data to develop daily work schedules, enabling proper staffing for departments for each shift.
  • Processed and approved all scheduling changes to client, staff, and executive calendars by using internal proprietary software.
  • Make and receive 100+ calls daily regarding staffing to client's homes and contracted facilities.
  • Scheduled doctor appointments and travel arrangements for average of 30 patients per day.
  • Created weekly production status reports for supervisor and director.
  • Developed strong working relationships with management and executive team through effective scheduling and communication skills.

Insurance Administrator

Conifer Health Solutions
06.2015 - 12.2020
  • Maintained working relationships with nursing staff and contracted providers.
  • Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends, and generating appeals for denied or underpaid claims.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Followed HIPAA on every interaction.
  • Researched contract terms/interpretation and compiled necessary supporting documentation for appeals, adjudication issues, and referral to refund unit on overpayments.
  • Follow specific payer guidelines for appeals submission and escalated exhausted appeal efforts for resolution.

Assistant Front End Manager

Giant
04.2014 - 05.2015
  • Responsible for store inventory to help control being out-of stock and decrease shrink based on movement data.
  • Worked on specific sales building displays and product positioning.
  • Created schedules for all front end staff weekly.
  • Maintained a positive and professional customer service oriented attitude while supervising store.
  • Trained employees in order to achieve desired results on company metrics.
  • Maintained financial accuracy by collecting deposits, fees and payments.
  • Monitored self-checkout systems and provided assistance where required.
  • Counted cash in register drawers of all employees at beginning and end of shift.
  • Processed POS transactions, including checks, cash and credit purchases or refunds.

Cage Shift Supervisor

Maryland Live Casino
07.2013 - 04.2014
  • Monitored transactions and ensured compliance with company internal controls, policies, laws and regulations.
  • Responsible for cage checks, inventory controls, and currency orders.
  • Handled consumer business flow to maintain break and shift scheduling.
  • Developed and ensured employees were trained on operational procedures.
  • Observed and monitored status and cash inventory levels of ticket redemption kiosk machines to support maximum performance and availability to casino guests.
  • Monitored and coordinated activities of cage personnel to maintain integrity of cage funds.
  • Opened and closed location and monitored shift changes to uphold successful operations strategies and maximized business success.

Customer Account Executive

Comcast
06.2011 - 03.2013
  • Responsible for call center support of customers' 70+ calls per day for video, phone, and internet repair.
  • Educated customers on diversity of all products and features in order to sell new lines of service.
  • Explained billing cycles, processes, and prorates effectively to ensure that customers understand their statements.
  • Processed payments, corrected errors and discrepancies on customers' billing statements.
  • Prepared work orders for utility construction visits and scheduled technicians for at home repair and new installations.
  • Achieved 4.0 overall yearly performance goals and consistently exceeded monthly performance metrics.
  • Performed network diagnostics to identify and resolve network configuration issues from the modem to the internet.
  • Possesses an excellent knowledge of windows operating systems, web browsers, e-mail and other PC operating and connectivity technologies.
  • Diagnosed PC operating system, router and cable modem and wiring issues.
  • Provided behavioral and competency feedback to call center supervisors regarding CAE performance in order to train employees.

Store Manager

TCC Verizon Wireless
11.2006 - 02.2011
  • Repeatedly promoted within TCC from repair technician to sales rep, assistant manager, and store manager.
  • Managed all store functions and supervised a sales team.
  • Responsible for the development and performance of all sales activities towards the achievement of maximum profitability.
  • Prepared action plans for effective search of sales leads and prospects and provided feedback to senior management regarding overall store performance.
  • Conducted one-on-one weekly and monthly reviews with all team members to build more effective communications, understand training, and to provide improvement of sales and activity performance.
  • Provided competitive pricing on all merchandise while striving to maintain maximum profit margin and controlled expenses to meet budget guidelines.
  • Recruited, interviewed, and hired sales representatives based on criteria agreed upon by senior management. Established plans and strategies to expand the customer base in the area by generating referrals and acquiring small business customers.
  • Conveyed the benefits of products/services to generate customer interest and build relationships with customers to find the right solution for their needs.
  • Used negotiating skills to identify opportunities and turn objections into sales, and consistently surpassed quotas.
  • Created automated daily reports that reduced inaccuracies and provided management with an important decision-making tool. Supervised all inventory of the fru phones for the Technical Service Department.
  • Updated software on every handset after inventory delivery. Repaired and replaced cell phones, pda's, and mobile broadband cards.
  • Created work orders for replacement phone units. Sold data plans and accessories to accompany the customer's handsets.
  • Designed presentations with the Quality Assurance Team regarding new products and trainings.
  • Set up merchandising display units for new product launches. Held monthly store meetings with employees regarding new products and training courses.

Assistant Manager

Pies-On-Pizza
09.1998 - 03.2006
  • Negotiated terms with vendors/suppliers for inventory delivery.
  • Was responsible for all daily collected revenue and weekly bank deposits.
  • Trained new employees on business computers systems and cash registers.
  • Up-sell appetizers, beverages, and desserts to increase guest check averages.
  • Follow up with guest tables to promptly fulfill additional requests and collect payments to balance transactions with receipts.
  • Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
  • Developed strong working relationships with staff, fostering a positive work environment.
  • Maintained a clean, safe, and organized store environment to enhance the customer experience.
  • Supervised day-to-day operations to meet performance, quality and service expectations.

Education

Some College (No Degree) - Public Administration

County College of Morris
Randolph Township, NJ

Diploma -

Jefferson Township High School
Oak Ridge, NJ
06.2002

Skills

    • Prior authorization processing
    • Insurance coverage verification
    • Relationship development
    • Medical terminology
      • Business operations
      • Problem resolution
      • MS Office, Excel, and Powerpoint

Accomplishments

  • Ranked #1 in the country for total sales in 2007 for Verizon Wireless and Flextronics combined.
  • Named "Employee of the Year" for 2007 and 2008.
  • Repeatedly named "Employee of the Month" in recognition of excellent job performance and customer service.
  • Helped drive a 10% increase in customer satisfaction (as measured by a customer survey in2007).
  • Helped drive a 35% increase in customer satisfaction (as measured by a customer survey in 2008).
  • Helped drive a 55% increase in customer satisfaction (as measured by a customer survey in 2009).

References

  • Sandy Weeks 240.832.1220 Conifer Health Solutions
  • Barbara Dowling 410.271.6311 Conifer Health Solutions
  • Darlene Coates 443.328.5799 Comcast
  • Jerry Grace 410.913.1123 Verizon Wireless
  • Michael Parrish 443.846.8908 Giant
  • Brandon Ament 410.299.9765 Flextronics
  • Ren Gilberti 973.271.6432 Pies-On-Pizza

Timeline

Commitment Record Specialist II

State Of Maryland
01.2023 - Current

Insurance Coordinator

Advanced Surgery Center
03.2022 - 01.2023

Scheduling Coordinator

Elizabeth Cooney Care Network
01.2021 - 02.2022

Insurance Administrator

Conifer Health Solutions
06.2015 - 12.2020

Assistant Front End Manager

Giant
04.2014 - 05.2015

Cage Shift Supervisor

Maryland Live Casino
07.2013 - 04.2014

Customer Account Executive

Comcast
06.2011 - 03.2013

Store Manager

TCC Verizon Wireless
11.2006 - 02.2011

Assistant Manager

Pies-On-Pizza
09.1998 - 03.2006

Some College (No Degree) - Public Administration

County College of Morris

Diploma -

Jefferson Township High School
KARA CHAPLIN