Lenore V. Carter
Palatka,Florida
Summary
Experienced claims professional with over 24 years experience in the medical insurance industry. Effectively manage multiple high priority projects and take pride in providing exemplary service. Excellent customer service and interpersonal skills.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Appeals Collector
Parallon
Tampa, FL
12.2019 - Current
- Responsible for performing follow up on all appeals submitted to the payer for a timely payment and resolution.
- Pursue additional payment on open appeals through various means of communication, such as online or via payment package processes with payers and patients.
- Overcome objections that prevent payment of the claim.
- Gain commitment for payment through concise and factual collection techniques.
- Escalate accounts to appropriate individuals at the payer and via SSC management as needed, including accounts with lack of timely payer response.
- Communicate trends to management as identified.
Quality Control Examiner (Auditor)
AvMed Health Plan
Gainesville, FL
12.2010 - 04.2019
- Audited claims adjudicated by the claims department.
- Performed claims analysis requested by management.
- Special projects related to provider issues as assigned.
- Prepared monthly reports for each employee and submitted them to manager.
- Perform routine follow up for all pending claims
Education
Medical Office Management Certificate -
Concorde Career Institute
Jacksonville, FL04.1994
Diploma - undefined
Palatka High School
Palatka, FL06.1990
Skills
- Amisys Advance
- Microsoft Word
- EXP Macess
- Microsoft Excel
- Concuit
- Microsoft Outlooky mmm
- Artiva
- Acuity
- Support Point
Accomplishments
- Successfully resolved 95% of collections-related issues.
- Consistently earned high-quality scores during post interaction customer surveys.
- Resolved product issue through consumer testing.
Certification
Medical Office Management
Timeline
Appeals Collector
Parallon
12.2019 - Current
Quality Control Examiner (Auditor)
AvMed Health Plan
12.2010 - 04.2019
Diploma - undefined
Palatka High School
Medical Office Management Certificate -
Concorde Career Institute