Michelle "Brooke" Carter
RCM AR SPECIALIST
Boiling Springs,SC
Summary
- Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex Dental & Medical claims. Committed to maintaining customer satisfaction and contributing to company success.
- Experienced AR Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities.
- Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
- Talented Leader with expert team leadership, planning and organizational skills built during successful careers. Smoothly equip employees to independently handle daily functions and meet needs. Diligent trainer and mentor with exceptional leadership abilities and results-driven approach.
- Efficient billing professional with years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
- Driven Oral Surgery AR Specialist, skilled in finding & resolving AR Issues with no negative effects on the practices. Offering strong background in Dental & Medical Insurance knowledge. Excelled at working for multiple doctors and practices and exceeding AR Goals. Compassionate & professional, known for being kind and respectful towards all teammates.
- Competent Accounts Receivable Specialist bringing years of experience carrying out all accounts receivable functions in high volume environments. Proficient in tracking payments, appealing & resolving billing issues. Recognized as dedicated, professional, driven to meet team targets, and enhance bottom-line performance.
- Hard-working individual with exceptional knowledge in dental/medical insurance terminology. An energetic Oral Surgery AR Specialist that enjoys beating AR deadlines and takes pride in the work done.
- Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
- Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
- Determined and experienced in mentoring and challenging team members to meet and exceed company goals.
Overview
10
10
years of professional experience
Work History
RCM- AR Specialist
Specialty Dental Brands
Remote
08.2022 - Current
- Worked with Numerous Dental Insurance Companies AND Medical Insurance Companies for a multi-location Oral Surgery Office
- Orchestrated Team Meetings & Huddles to accomplish better communication processes
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Followed up on denials, late payments, extensions and other special circumstances.
- Resolved discrepancies in insurance payments by collaborating with carriers.
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Processed eligibility and benefits verification and authorization requests.
- Maintained confidentiality of patient finances, records, and health statuses.
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
- Researched and resolved routine and complex issues.
- Communicated effectively with members of operations, finance and clinical departments.
- Utilized DSN to document and track customer account details.
- Monitored changes in insurance industry to stay compliant with relevant laws and regulations.
- Investigated and processed claims swiftly to keep customers satisfied.
- Obtained underwriting approval by completing application for coverage.
- Negotiated with insurance underwriters to obtain better coverage and improved rates for clients.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Updated patient records with accurate, current insurance policy information.
- Posted payments to accounts and maintained records.
- Generated reports to track insurance verifications and claim progress.
- Chased insurance companies to achieve accurate and timely payments.
- Performed various administrative tasks by filing, copying and faxing documents.
- Assisted with medical coding and billing tasks.
- Processed medical insurance claims and payments.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Managed office bookkeeping with insurance billing and patient payments.
- Audited and corrected billing and posting documents for accuracy.
- Handled account payments and provided information regarding outstanding balances.
- Maintained accurate records of customer payments.
- Generated accounts payable reports for management review to aid in financial and business decision making.
- Verified insurance and communicated coverage to staff and patients.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Obtained prior authorization and precertification for outpatient procedures.
- Filed and tracked insurance claims and communicated claims status to patients.
- Prepared insurance claims for submission to clearinghouses or insurance companies.
- Referenced monthly aging reports to follow up on unpaid claims and obtain maximum reimbursement.
- Maintained compliance with local, state and federal regulations governing insurance, Medicare and Medicaid requirements.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Generated, posted and attached information to claim files.
- Generated, posted and attached information to claim files.
- Calculated adjustments, premiums and refunds.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Coordinated with contracting department to resolve payer issues.
Dental Treatment Coordinator
ProGrin Dental
Boiling Springs, SC
04.2018 - 08.2023
- Communicated with insurance companies to dispute unpaid claims and verify patient coverages.
- Prepared insurance claim forms, explained benefits, and outlined pricing details for procedures and services.
- Understood dental terminology and insurance breakdowns to communicate with external stakeholders.
- Managed patient billing processes for timely, accurate payments.
- Scheduled, rescheduled and cancelled appointments for dental patients
- Provided excellent customer service to create positive experiences and build patient trust.
- Went over very detailed dental treatment plans for a large office with 5 doctors, & 10 dental assistants.
- Work regularly with patients needing IV Sedation for dental treatment.
- Scheduled everything from: Exams, x-rays, standard cleanings as well as scaling & root planing, fillings, crowns, root canals, extractions, flippers, partials, bridges, bone grafts, sinus augmentations, single implants, full mouth implants, implant supported dentures, implant supported bridges, and dentures.
- Helped patients complete necessary medical forms and documentation.
- Prepared insurance claim forms, explained benefits and outlined pricing details for procedures and services.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Greeted visitors and initiated processes for clients to streamline patient flow.
- Coordinated referrals through insurance and other specialists and documented details in patient charts.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Received and processed stock into inventory management system.
- Worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
- Offered friendly and efficient service to all customers, handled challenging situations with ease.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Used Microsoft Word and other software tools to create documents and other communications.
- Collected payments, sent claims, and set patients up for due consents or Care Credit
Advanced Scheduling Coordinator
Spartanburg Regional Medical Center
Spartanburg, SC
07.2017 - 04.2018
- Achieved promotion from Patient Access Representative to Advanced Scheduling Coordinator after first 90 day period due to performance
- Experience scheduling patients for physical therapy, speech therapy, occupational therapy, wheelchair seating evaluations, Functional Capacity Evaluations and pre work screens
- Handle high volume calls
- Contact referring doctors offices as needed daily to obtain patient diagnosis, order, demographics, insurance, and contact information daily to have them scheduled for their evaluations
- Scheduled patients for correct treatment based on their diagnosis.
- Verify insurance while scheduling patient
- Obtain patient information in their chart
- Verify with referring doctor offices patient status
- Key in new patients new insurance information
- Contact patients via phone, email, and mail
- Help at front desk for check ins, check outs and more scheduling as needed
- Block, change and fix Clinicians schedules as needed or requested
- Meet with managers daily for accurate patient and doctor responses
Client Service Representative/Universal Banker
Palmetto Bank
Boiling Springs, SC
04.2013 - 07.2017
- Schedule and confirm appointments for clients, customers, or supervisors.
- Locate and attach appropriate files to incoming correspondence requiring replies.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Vast Experience in Increasing Sales
- Performs Fund Transfers
- Process Stop Payments
- Inquiries about bank deposit products and service charges
- Assist with transactions
- Check Verification requests by third parties
- Research and Resolve customer problems
- Acts as customer Liaison
- Initiate "Reg E" disputes when appropriate including completion of all necessary documents and affidavits
- Balance Customer checkbooks
- Maintain documents and files for branch audit
- Teamwork Orientation Requests
- Coordinates loan documentation preparation
- Provides general customer services to bank customers and account holders
- Schedules appointments and meetings for supported staff
- Performs data entry as needed
- Answers High Volume Calls
- Collect and deposit money into accounts
- Disburse funds from cash accounts to pay bills or invoices
- Keep records of collections and disbursements
- Ensure accounts are balanced
- Operate office equipment, such as fax machines, copiers, or phone systems and arrange for repairs when equipment malfunctions
- Set up and manage paper or electronic filing systems, recording information, updating paperwork, or maintaining documents, such as attendance records, correspondence, or other material
- Greet visitors or callers and handle their inquiries or direct them to appropriate persons according to their needs
Education
High School Diploma -
Boiling Springs High School
Boiling Springs, SC06.2009
Skills
- Outstanding LEADER
- Revenue Cycle Training
- Insurance billing
- CRM Tracking
- Filing Appeals
- Oral Surgery Dental AND Medical coding
- Oral Surgery Dental AND Medical terminology
- Accounts Receivable Expertise
- Coding Proficiency
- Monthly Reconciliations
- Account Reconciliation
- Codes Reviewing
- Benefits Verifications
- Payment Management
- Aging Reports Analysis
- Credit and Collections
- Claim Processing
- Team Bonding
- Financial Records and Reporting
- Financial Transactions
- Accurate Payment Posting
- Accurate Adjustment Posting
- Billing Dispute Resolution
- Accurate spreadsheets
- Solution Development
- Diagnostic Codes
- Data management
- Team leadership
- Self-motivated
- Detail Oriented, Accurate and Efficient Writing
- Strong knowledge of email and scheduling
- Office Support Specialist
- Well Organized
- Team Player
- Document Organization
- Excellent Customer Service Skills
- Spreadsheets and Journal Entries
- Prioritize duties efficiently
- Time Management
- Vast experience in increasing sales
- Ability to Multitask
- Excel, Microsoft Outlook, Microsoft Word
- Great Problem Solver
- Strong verbal communication
- Project management
- Conflict resolution
- Staff development
- Client assessment and analysis
- Scheduling Patients
- Contacting Doctors
- Experience Referral Coordinator
- Experienced with Diagnosis
- Oral Surgery staff support
- Understanding of confidentiality laws
- Cross-Functional Team Collaboration
- Excellent multitasking capability
- Proficiency in program Dental Intelligence
- Adept at multi-line phones
- Research
- Critical thinking
- Good telephone etiquette
- DSN Software proficiency
- Revenue Cycle Management
- Outstanding LEADER
- Dentrix software proficiency
- Billing Procedures
- Supply Oversight
- Inventory Tracking
- Advanced Excel Spreadsheet Functions
- Excellent Oral and Written Skills
- Electronic Filing System
- Team Meetings
- Accounts Payable and Accounts Receivable
- Employee Evaluation
- Past Due Balance Management
- Prior Authorization Processing
Accomplishments
- Achieved multiple "Grinny Awards" at my current dental office for exceeding the expectations of upper management, along with our patients as well.
- Successfully & Efficiently managed 5 doctor schedules for a high volume office
- After only 9 months of being a reception for our Dental Practice, i was promoted to the Treatment Coordinator.
- Top Performer, The Palmetto Bank
Timeline
RCM- AR Specialist
Specialty Dental Brands
08.2022 - Current
Dental Treatment Coordinator
ProGrin Dental
04.2018 - 08.2023
Advanced Scheduling Coordinator
Spartanburg Regional Medical Center
07.2017 - 04.2018
Client Service Representative/Universal Banker
Palmetto Bank
04.2013 - 07.2017
High School Diploma -
Boiling Springs High School
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