PRISCILLA CARTER
Pompano Beach
Summary
Resourceful and detail-oriented professional with strong analytical and communication skills developed in fast-paced claims and healthcare environments. Proven ability to manage high volumes of complex information with precision and efficiency. Known for improving operational processes, enhancing customer satisfaction, and maintaining regulatory compliance (including HIPAA). Eager to transition into a new field where problem-solving, collaboration, and adaptability contribute to business success.
Overview
7
7
years of professional experience
Work History
Fraud Claim Representative (Remote)
Genpact
Chicago
07.2023 - 12.2024
- Resolved escalated claims and conducted in-depth analysis for timely resolution
- Processed high-volume claims in a fast-paced, deadline-driven environment
- Investigated suspicious activity to detect potential fraud and mitigate risk
- Improved system efficiency through update implementation and communication tracking
- Delivered professional customer service for inquiries regarding claims and denials
- Promoted collaboration and productivity through effective interdepartmental communication
Certified Medical Assistant
Internal Medicine Associates
Tamarac
02.2018 - 03.2020
- Scheduled procedures, verified insurance, and ensured HIPAA compliance
- Collected and documented patient vitals and health history in EMR
- Assisted physicians during exams and maintained sanitized, organized exam rooms
- Managed over 30 daily calls and appointment requests while protecting patient privacy
- Processed prescriptions and coordinated pharmacy requests
- Handled patient payments, posted transactions, and balanced daily cash reconciliation
- Assisted in minor surgical procedures such as suturing lacerations or removing stitches under the direction of a physician.
- Conducted diagnostic tests such as EKGs or hearing screenings in accordance with established protocols.
- Maintained accurate records of patient visits including diagnosis information, treatment notes, prescriptions.
- Administered rapid tests for COVID and strep to help clinical staff assess conditions.
- Reviewed clinical data from medical records to assign ICD, CPT, and HCPCS codes.
- Interpreted medical terminology and pharmacological information to translate information into coding system.
- Reviewed patient records and assigned accurate codes for diagnoses and procedures.
Education
High School Diploma -
Florida Career College / Brookshire International Academy
Lauderdale Lakes, FL09.2017
Skills
- Microsoft Office Suite
- EMR Systems
- Claims Management
- Data Analysis
- Documentation Review
- Fraud Investigation
- Scheduling
- Recordkeeping
- Insurance Verification
- Time Management
- Team Collaboration
- Communication
- Problem Solving
- HIPAA Compliance
- Confidentiality
- Patient Data Privacy
- Attention to detail
- Data entry accuracy
- Resolving escalated claims
- ICD-9 coding experience
Timeline
Fraud Claim Representative (Remote)
Genpact
07.2023 - 12.2024
Certified Medical Assistant
Internal Medicine Associates
02.2018 - 03.2020
High School Diploma -
Florida Career College / Brookshire International Academy