Pamela Parker

Care Coordinator III

Centene Healthcare/Carolina Complete Health, Charlotte, NC

• Reviewed documentation for appropriate CPT, ICD-10-CM, and HCPCS coding
• Processed 60 preauthorizations per day via telephone, faxes and online portal
• · Contact Centers for Medicare and Medicaid Services (CMS) directly
• · Verification of benefits for governmental, commercial and third-party carriers
• · Communicated with insurance companies to resolve outstanding claims
• · Served members and/or provider inquiries, requests via telephone, email, faxes and online portal
• · Maintained HIPAA compliance and patient confidentiality

• Conducted comprehensive benefits verification to ensure patient eligibility and coverage accuracy.
• Collaborated with healthcare providers to gather necessary documentation for benefit determinations.
• Utilized electronic health record systems to track and manage patient benefits information efficiently.
• Enhanced claim processing efficiency by reviewing and verifying insurance benefits information.

• Managed patient billing inquiries and resolved account discrepancies efficiently.
• Monitored accounts receivable reports to identify outstanding balances and follow-up actions.
• Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
• Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
• Posted payments and processed refunds.

• Coordinated patient care plans, ensuring timely access to services and resources.
• Managed communication between patients, healthcare providers, and insurance companies.
• Evaluated case documentation for compliance with regulatory standards and best practices.
• Maintained current knowledge of medical terminology, insurance policies, and healthcare trends to ensure accurate case coordination and informed decision-making.
• Provided exceptional customer service, resolving patient inquiries and concerns in a timely and compassionate manner.