Summary
Overview
Work History
Education
Skills
Timeline
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Karen Sparkman

Sewell,NJ

Summary

Analytical and focused Insurance Analyst known for high productivity and efficient task completion. Possess specialized skills in risk assessment, policy analysis, and claims management. Excel in critical thinking, problem-solving, and decision-making. Use these soft skills to navigate complex insurance landscapes and contribute to team success. Dedicated claims analyst remaining calm and poised in all types of situations. Bilingual and offering a great set of skills. Pursuing a similar role with a great organization. . Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes. Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.

Overview

18
18
years of professional experience

Work History

Coordination of Benefits Analyst

Seamless Access
Sewell, USA
08.2019 - Current
  • Performed clerical tasks such as filing, faxing, copying., as requested.
  • Reviewed benefit plans for accuracy of coding changes when necessary.
  • Handled cash transactions accurately according to established procedures.
  • Collaborated closely with clinical staff members regarding scheduling conflicts or cancellations due to unforeseen circumstances.
  • Provided guidance on proper completion of forms related to registration processes.
  • Followed up with insurance companies regarding denials of claims or incorrect reimbursements amounts.
  • Greeted patients and visitors, verified patient information, and collected copayments for services rendered.
  • Scheduled appointments for patients using an electronic medical record system.
  • Conducted insurance eligibility verifications to ensure coverage of services provided.
  • Assisted patients with questions regarding their accounts or billing issues.
  • Maintained accurate patient records in accordance with HIPAA regulations and organizational policies.
  • Ensured all forms were completed accurately, including insurance information and other demographic data.
  • Resolved discrepancies between patient accounts receivable balances and third-party payers' remittance advice reports.
  • Maintained confidentiality of patient information at all times in compliance with HIPAA regulations.
  • Monitored account status on a regular basis to identify any follow-up that may be needed.
  • Verified insurance benefits prior to patient visits to maximize reimbursement potential.
  • Answered incoming calls from patients or providers seeking assistance or providing updates on existing cases.
  • Entered data into the computerized registration system to update patient demographics records.
  • Prepared patients for departure by coordinating discharge plans and paperwork.
  • Interpreted physician orders to coordinate appropriate tests and verify compliance with admission criteria.

Coordination of Benefits Analyst

INDEPENDENCE BLUE CROSS
10.2016 - Current
  • Coordinate insurances by setting primacy based on the rules of NAIC (subscriber/dependent, birthday rule, etc.).
  • Research and investigate other insurances sent via monthly reporting.
  • Research Medicare coverages, and set primacy based on entitlement reason, group size, and type of coverage.
  • Add Medicare Parts C and/or D into the company's database for accurate billing and payments.
  • Contact the other insurance companies to verify original effective dates, lapses in coverage, and termination dates, when applicable.
  • Use of company applications and databases, such as Insinq, Liq, OCWA, ECS, OPIS, AAA, and ICIS, to research the presence of other insurances.
  • Tracking trends in coordination.
  • HIPAA and PHI/PII trainings.
  • Workers' compensation and MVA insurance coordination and claims payments.
  • Analyzed employee benefit plans and recommended changes to ensure cost-effectiveness.
  • Developed detailed reports on benefits utilization, costs, trends and variances.
  • Participated in annual open enrollment meetings with employees to explain plan changes or options.
  • Compiled data from multiple sources into comprehensive reports outlining current benefit program information.

Medical Billing Specialist

KENNEDY HOSPITAL
06.2014 - 01.2015
  • Responsible for collecting payments and managing patients' accounts.
  • Responsible for submitting claims and making follow-up calls with the provider and insurance carrier.
  • Research Medicare coverages, and set primacy based on entitlement reason, group size, and type of coverage.
  • Tracking and reporting the status of delinquent accounts.
  • Performing various collection actions, including contacting patients via telephone to discuss payment collection information.
  • Initiated collection efforts on unpaid accounts by contacting insurance companies or patients directly via phone or mail.
  • Provided customer service support to patients who had questions about their bills or payments due.
  • Researched complex billing issues involving multiple providers or services rendered over a period of time.
  • Generated monthly invoices for patients based on services provided according to established fee schedules.
  • Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
  • Assisted with the reconciliation of accounts receivable ledgers at month-end close process.
  • Processed credit card payments from patients in accordance with office policy.
  • Updated patient accounts with information obtained from internal departments or external sources.
  • Monitored aging accounts receivable balances ensuring timely resolution of outstanding balances.
  • Performed quality assurance audits on submitted claims ensuring that they met industry standards.
  • Developed strategies for improving collections performance while reducing bad debt write-offs.
  • Reviewed patient records for accuracy and completeness of information in medical billing system.

Claims Processor

AMERIHEALTH CARITAS
02.2014 - 06.2014
  • Accurately adjudicated claims in compliance with data rules, policies, and the contractual agreement.
  • Reviewed suspended claims on a regular basis, assuring that all documentation has been attached and completed before the adjudication process.
  • Research Medicare coverages, and set primacy based on entitlement reason, group size, and type of coverage.
  • Reviewed audit results on a weekly basis, correcting errors within a specific time frame to verify original effective dates.
  • Verified eligibility, benefits, authorization requirements for services rendered.
  • Resolved discrepancies between provider's billings and insurance contracts.
  • Applied knowledge of insurance plans, regulations and guidelines in adjudicating claims.
  • Performed data entry into various systems related to claims processing tasks.
  • Reviewed and processed medical and dental claims to ensure accuracy of information.
  • Investigated, researched and responded to customer inquiries regarding billing issues.
  • Reviewed submitted documentation from providers for completeness prior to submitting claims.

Medical Biller and Coder

PATHS,LLC
Collingswood, USA
04.2011 - 01.2013
  • Reviewed patient bills for accuracy and completeness and obtain any missing information
  • Required Knowledge of insurance guidelines especially Medicare and Medicaid
  • Followed up with unpaid claims with in standard billing cycle time frame
  • Checked each insurance payment for any discrepancy if necessary identify and bill the secondary or tertiary insurances
  • Reviewed All accounts to insure all insurance and patient follow-up were completely

Insurance Claims Specialist

Electric Mobility Health Inc.
Sewell, USA
09.2006 - 04.2011
  • Verifying benefit eligibility.
  • Selecting the appropriate insurance, and entering all necessary billing information.
  • Communicate with Sales and Customer Care for the priority handling of patients.
  • Follow up with department emails, authorizations, and faxes.
  • Adhering to processes according to department procedures.
  • Obtaining missing information from patients and providers.
  • Corresponding with patients on an inbound/outbound system, communicating daily with health care professionals.
  • Responsible for securing, verifying, and submitting all information to the patient's insurance carrier.
  • Processed claims submitted through various insurance carriers.
  • Corresponded with various insurances, COBRA, life, and health insurance throughout the United States and Canada.
  • Responsible for collecting past-due balances.
  • Enforcing payment arrangements on overdue insurance claims.
  • Collaborated with team members to identify trends in customer issues and develop solutions accordingly.
  • Negotiated settlements between claimants and insurers when necessary to resolve disputes quickly.
  • Advised customers on how they can protect themselves from potential risks associated with their policies.
  • Knowledge of claims support, claims manager, and SAP.
  • Updating all invoices

Education

Associate's Degree - Media Communications

GLOUCESTER COUNTY COMMUNITY COLLEGE
06.2002

High School -

WASHINGTON TOWNSHIP HIGH SCHOOL
Washington Township, NJ
01.1999

Skills

  • Medic
  • Workers' Compensation
  • Medical billing
  • SAP
  • HIPAA
  • Medical coding
  • Epic
  • Accounts Receivable
  • Databases
  • Insurance verification
  • Medicare
  • Medical office experience
  • Hospital experience
  • CPT Coding
  • Medical terminology
  • Medical Records
  • Employee benefits laws
  • HR compliance
  • Verbal and written communication
  • New employee orientations
  • Special projects
  • Customer Service
  • Microsoft Powerpoint
  • Communication Skills
  • ICD-10
  • Microsoft Excel
  • Patient Care
  • Triage
  • Transcription
  • ICD-9
  • Computer Skills
  • Proficient in Excel
  • Microsoft office
  • Power Point
  • Knowledge of the inner and outer workings of insurance and member relations
  • Great time management skills
  • Ability to multitask
  • Multitasking
  • Team building

Timeline

Coordination of Benefits Analyst

Seamless Access
08.2019 - Current

Coordination of Benefits Analyst

INDEPENDENCE BLUE CROSS
10.2016 - Current

Medical Billing Specialist

KENNEDY HOSPITAL
06.2014 - 01.2015

Claims Processor

AMERIHEALTH CARITAS
02.2014 - 06.2014

Medical Biller and Coder

PATHS,LLC
04.2011 - 01.2013

Insurance Claims Specialist

Electric Mobility Health Inc.
09.2006 - 04.2011

Associate's Degree - Media Communications

GLOUCESTER COUNTY COMMUNITY COLLEGE

High School -

WASHINGTON TOWNSHIP HIGH SCHOOL

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Karen Sparkman