Marlana Carter
Theodore,Alabama
Summary
Pursuing a career in the Medical Industry as an (H.I.M. Supervisor) that is motivating and rewarding, where I can utilize my qualifications. And my abilities and education to contribute to the success and to be an asset to the medical health field and to provide quality care. Knowledge of Anatomy and analysis skills.
A dependable, skilled and experienced professional with a high degree of integrity and motivation. Working towards the complication of any given project(s), and individual with a proactive approach towards handling any issue. Organizational skills and great communication skills. Self-aware and prioritize management skills. The Ability to delegate ideas and discussions. Working well with others and maintaining focus. Strong leadership and team-oriented. Goal-oriented professional effective at dealing with individuals during stressful and confusing situations to address benefits needs and navigate agency structures. Practiced at working with regulatory limits and department standards to handle requirements via email, letter, telephone calls and in person. Offering several-year background generating new business by selling various insurance plans. Enthusiastic client services professional with strong background directly interfacing with industry customers. Well-versed in products, services and consumer trends. Dependable achiever committed to holding highest ethical standards and maintaining customer trust. Reliable Customer Service Representative with extensive track record in demanding sales and account management environments. Strong presenter, communicator and problem solver working effectively and productively with diverse customers and individual needs.
Overview
16
16
years of professional experience
Work History
Customer Service Advocate
MPF Federal -Optum VACCN Community Care Network
Remote
01.2021 - Current
- Developed relationships with customers through friendly conversations.
- Resolved customer complaints via phone, email, mail, or social media.
- Followed up on customer inquiries not immediately resolved.
- Attended weekly meetings on changes in processes that affect the organization's ability to provide excellent service.
- Established appropriate disciplinary actions when necessary according to established policies.
- Attended coaching clinics or workshops in order to stay up-to-date on industry trends.
- Encouraged players with positive reinforcement during game play or practice sessions.
- Instructed players on proper techniques, strategies, rules and regulations of the sport.
- Developed policies and procedures related to medical coding processes.
- Adhered to HIPAA regulations when handling confidential patient information.
- Verified patient information, including medical history and insurance coverage, to ensure accuracy of coding and billing.
- Analyzed trends in denials in order to recommend process improvements which would reduce the number of denials received.
Supervising Agent
Liberty National Life Insurance/The Mitchell Agency
08.2019 - 10.2020
- Provided guidance and direction to subordinates regarding job duties and responsibilities.
- Monitored employee productivity levels on a regular basis to identify areas of improvement.
- Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
- Tracked progress on projects and provided timely feedback to staff members.
- Performed market research activities for identifying new leads for potential customers.
- Attended conferences, seminars, networking events and webinars to build relationships with potential customers.
- Coordinated with underwriters and actuaries to ensure timely processing of applications.
- Advised clients on how they can maximize returns from their investments in life insurance policies.
Medical Billing and Coding Specialist/H.I.M. Supervisor
Community Hospital of Long Beach
04.2013 - 06.2018
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Collaborated with billing team to confirm no additional diagnosis codes available for LCD and NCD coverage.
- Responded to coding questions from callers and other internal departments.
- Entered charge rationale in patient account notes.
- Developed policies and procedures related to medical coding processes.
- Analyzed trends in denials in order to recommend process improvements which would reduce the number of denials received.
- Adhered to HIPAA regulations when handling confidential patient information.
- Verified patient information, including medical history and insurance coverage, to ensure accuracy of coding and billing.
- Researched current trends in medical billing practices and updated course content accordingly.
- Verified accuracy of claims prior to submission for payment ensuring compliance with payer requirements.
- Maintained current knowledge of industry changes related to ICD-10 and CPT codes by attending seminars and webinars.
- Trained new coders on proper use of ICD-10 codes and CPT codes.
- Prepared reports summarizing findings from audit reviews for management review.
- Performed data entry to update patient information in a timely manner.
- Provided guidance and assistance to other HIM staff on departmental procedures.
- Prepared correspondence related to patient health information requests.
- Conducted quality assurance reviews of medical records to ensure accuracy of coding and billing information.
Mental Health Specialist/Floor Supervisor
Extended Care Hospital/Westminster TRC
01.2009 - 03.2013
- Provided crisis intervention services as needed in order to ensure safety of clients.
- Coordinated referrals to external agencies or specialists when additional support was required by clients.
- Actively listened while engaging with clients during one-on-one counseling sessions.
- Created detailed reports documenting interactions with clients and progress towards goals.
- Educated staff members on the importance of providing culturally competent services to diverse populations.
- Participated in weekly team meetings to discuss client cases and review treatment plans.
- Collaborated with other healthcare providers to coordinate comprehensive care for clients.
- Maintained detailed records of client progress in accordance with HIPAA regulations.
- Educated families about mental illness and its impact on daily life.
- Attended professional development workshops and conferences related to mental health advocacy practices.
- Provided psycho-social education classes related to topics such as self-care techniques and relapse prevention strategies.
- Facilitated group therapy sessions for individuals with various mental illnesses.
- Educated clients about available resources in the community.
- Collaborated with psychiatrists, psychologists, case managers and other clinical staff in providing comprehensive services to clients.
- Assisted homeless individuals in accessing shelters, food pantries, medical clinics and other supportive services.
Education
Bachelor of Science - Social Sciences Education
New Charter University
Salt Lake City, UT06-2023
Associate of Science - RHIT, Medical Billing And Coding With Honors
Rasmussen University
Ocala, FL12-2019
High School Diploma -
Harrison Central High School
Gulfport, MS05-1996
Skills
- Knowledge of Anatomy
- Analysis skills
- Working with Microsoft Word
- Working with Microsoft Office Program
- Working with Excel
- Power Point
- Typing 90 WPM
- Performing risk assessments
- Medical Records Tech
- Monitoring and supporting Teams in Remote work environment
- Verifying demographic information for billing purposes
- Preparing charts and encounter tickets
- Accuracy of CPT and ICD-10 ICD-9 codes
- Providing appropriate coding and documentation
- Processing all medical records requests
- Following HIPAA and Risk Management guidelines and policies
- Documentation Review
- Checking Appeals and Denials Medical and Dental Claims
- Experience with remittance and recoupment refunds
- Experience with Medicaid Out of network
- Working with all clients Inpatient and Outpatient
- Admissions
- LPS Holds
- Police Holds
- Prescription drug programs (Detox)
- Pre-certifications
- Referral request
- Urgent care UCERN request
- Checking all insurances through the OneSource Passport System
- Cross-checking Medical insurance
- Documentation and receiving Authorizations from Magellan
- MHN (Health-Net)
- United Healthcare and more
- Obtaining Medical Records electronically through the Epic System
- Reviewing daily reports and admissions of Detox
- Geriatric
- Severe and Persistent Mental illness Cases
- Providing all referral resources daily
- Working closely with PET Clinicians/Psychiatrist Team
- Working with Saad Healthcare
- Working with Definitive Healthcare as a Clinical Consultant
- Working for Travers Consulting
- Creating USA Report Designs for Cerner Health System/Epic Health Systems
- Working in the mobile county hospitals
- Setting up Physicians and Nurses with Messenger App for Share Safe
- Account Management
- Promotional support
- CRM Software
- Complaint resolution
- Computer Proficiency
- 10-Key
- Process Optimization
- Problem-solving abilities
- Office equipment proficiency
- Microsoft PowerPoint
- Schedule mastery
- Microsoft Office Suite
Personal Information
Title: BLS CPR (Adult/Child/Infant) Certified, AHIMA, HCPCS RHIT – Health Information Technician, Bachelor’s degree in Social Sciences: Epic Certified & Cerner Certified/Hospital Software, Medical Billing and Coding with Honors Certified/Software Med Net and Citrix
Accomplishments
- Honor Roll graduate
- Dean list
- Leadership award
Timeline
Customer Service Advocate
MPF Federal -Optum VACCN Community Care Network
01.2021 - Current
Supervising Agent
Liberty National Life Insurance/The Mitchell Agency
08.2019 - 10.2020
Medical Billing and Coding Specialist/H.I.M. Supervisor
Community Hospital of Long Beach
04.2013 - 06.2018
Mental Health Specialist/Floor Supervisor
Extended Care Hospital/Westminster TRC
01.2009 - 03.2013
Bachelor of Science - Social Sciences Education
New Charter University
Associate of Science - RHIT, Medical Billing And Coding With Honors
Rasmussen University
High School Diploma -
Harrison Central High School
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