Sharon Carmichel
Springfield,MA
Summary
Initiative-taking, skilled in medical billing, claims, administrative work, member enrollment, and medical administration; certified in these areas; proficient in managing high call volumes in a demanding work environment while focusing on member enrollment and providing the best possible customer service; able to multitask promptly when needed. Fill out insurance claim forms or other relevant paperwork, then make sure everything is correct. of adjusting to shifts in the medical field and looking for a long-term job where I may use the newly acquired talents for a career, Capability to work with others. Ambitious Enrollment Specialist with exemplary listening and communication skills. Adept at planning, organizing and facilitating enrollment process. Dedicated to keeping customers happy and maximizing employee participation.
Overview
11
11
years of professional experience
Work History
Senior Healthcare
Guardian Angel
Springfield
06.2022 - Current
- Provided personal hygiene and bedside care, including assistance with walking
- Preserved documentation of rendered services and client advancement and promptly informed the manager or supervisor of any modifications to the client's state
- Monitored vital signs and administered medicine, among other healthcare-related tasks, for qualified nurses or physiotherapists
- Attended case reviews, collaborating with the client's care team to determine the needs of the client and create a plan for further support
- Provided companionship, personal care, or support in adjusting to a new lifestyle, helping individuals or families during periods of disability, disruption of the family unit, or recuperation.
Remote Enrollment Specialist
Wipro Limited/Cigna
Remote
09.2023 - 12.2023
- Evaluated eligibility for the plan and enrolled participants in accordance with CMS criteria
- Utilizing MARx, State Medicaid, USPS, and customer, physician, and/or agent outreach programs, enrolled members who had submitted incomplete or inaccurate applications
- Managed plan modifications, cancellations, and disenrollments in accordance with CMS regulations
- Fulfilled the requirements for membership revalidation and the eligibility rules for membership modifications
- Responded to eligibility-related queries via email and internal inquiry systems after investigation
- Reconciled and preserved all enrollment eligibility in compliance with Internal Client Medicare standards and procedures
- Complied with requests for research or special projects.
Call Center Representative
KNFT Staffing/Automated Health systems
Springfield
06.2023 - 09.2023
- Conveyed information about goods and services, accepted orders, terminated accounts, gathered complaints, and more to clients over the phone or in person
- Observed measures that were made
- Verified that the modifications necessary to address the concerns of the clients have been implemented
- Reached out to customers to answer questions, inform them of the outcome of a claim inquiry, or let them know about any upcoming changes
- Calculated the cost of the services requested, collected payments or deposits, or set up billing.
Remote Enrollment Specialist
Wipro Limited/Cigna
Remote
09.2022 - 05.2023
- Enrolled participants and determined eligibility for the plan in compliance with CMS guidelines
- Enrolled members with incomplete or erroneous applications by using Marx, State Medicaid, USPS, and customer, physician, and/or agent outreach programs
- Processed disenrollments, cancellations, and changes to plans in compliance with CMS guidelines
- Completed membership revalidation and applied eligibility rules for membership amendments
- Investigated questions about eligibility and sent responses via email and internal inquiry systems
- Reconciled and archived all enrollment eligibility in compliance with Internal Client Medicare standards and procedures
- Complied with requests for special projects and/or research.
Home Health Aide
Golden Heart
Springfield
07.2021 - 06.2022
- Provided personal care or bedside aid, such as walking or help with personal hygiene
- Prepared and kept track of client progress and services rendered, informing management or supervisor of any changes in the client's condition
- Performed duties pertaining to healthcare, such as medicine administration and vital sign monitoring, under the supervision of physiotherapists or licensed nurses
- Took part in case reviews and conferred with the client's care team to assess the client's needs and plan for follow-up services
- Assisted individuals or families with personal care, companionship, and assistance transitioning to new lifestyles during times of incapacitation, family disturbance, or recuperation.
Case Manager Specialist
Collabera
Bloomfield
03.2020 - 05.2020
- Made decisions about claims, created communication, and met customer experience requirements to ensure customer satisfaction with processed short-term disability and total absence claims
- Familiarity with widely accepted theories, methods, and protocols for managing disabilities and leaves of absence in each field
- Knowledgeable about utilizing communication and claims methods
- Relied on pre-established norms and instructions to conduct job-related tasks
- Operated under close observation
- Reported to a manager or supervisor
- Performed administrative duties such as keeping track of documents and managing insurance renewals.
Site Coordinator
Accountemps
Springfield
10.2019 - 12.2019
- Established and maintained a process for reviewing Direct Contact sheets for all Springfield, Holyoke, and Northampton Department and promptly managed data pertaining to billable services and the demographics of the people they serve
- Kept an eye on daily error reports to ensure errors are fixed
- Served as a point of contact for service and contract billing concerns between the DDS program staff and the billing department
- Helped teach the front desk staff at the DDS site in various administrative procedures and prepared productivity and utilization reports for the DDS programs.
Medical Billing
The Staffing Group (Temp Agency)
Salem
12.2018 - 02.2019
- Used an accounting software-programmed computer to record, store, and analyze data
- Verified numbers, postings, and papers for accurate math, correct entry, and appropriate CPT/HCPCS codes
- Utilized specialist software for professional claims, debit, credit, and total accounts are maintained on databases and computer programs
- Used copy machines, typewriters, and 10-key calculators to generate documents and conduct computations before shipping them to insurance companies to be paid
- Received, documented, bank vouchers and checks
- Complied with hospital claim-related financial, statistical, and accounting auditing reports and tables
- Identified and reported any disparities discovered in patient records
- Identified and fixed payer issues by looking through the payer's website or contacting the payer provider relations department
- Assessed patient accounts to determine insurance coverage
- Filled out claim forms or other relevant paperwork and made sure they are complete.
Ambulance Billing
KBW (Temp Agency)
Crowley
12.2018 - 02.2019
- Found data input problems and fixed them or notified supervisors of them
- Gathered, ordered, and double-checked data accuracy before entry
- Compared data with source documents or re-entered data in verification format to find errors
- Stored complete documents in appropriate locations
- Selected materials needed to complete work assignments
- Coded claims for submittal to various health, auto, and workers compensation insurance providers as well as Medicare and Medicaid
- Had basic familiarity with medical terminology and coding guidelines
- Located and corrected data entry errors or reported them to supervisors.
Patient Account Representative
Accountemps (Catholic Medical Center)
Manchester
09.2018 - 11.2018
- Logged any costs that needed to be billed, updated the accounts receivable system with patient and third-party payments, changes, and denials
- Monitored bills and examined self-pay and unresolved third-party accounts
- Discussed appropriate resolutions (internal and external) to ensure prompt and full payment and made contacts
- Examined every account to determine refunds and rebilling
- Made daily deposits and reconciled them.
Medical Claims Administrator
NuLife (Contego)
Manchester
04.2017 - 04.2018
- Verified insurance, posted charges, and processed claim forms accurately and promptly to ensure timely and accurate collection of accounts receivable
- Investigated and reconciled third-party denials and recognized and addressed trends in third-party reimbursement
- Filed insurance and patient bills, emailed or transmitted paper claims in a timely manner, kept track of daily charges, applied contractual adjustments and other adjustments for patients under contract for managed care, and monitored logs to ensure claims are filed and received correctly
- Promptly rebilled rejected claims from Corrections
- Contacted insurance companies to confirm claims were received
- Posted refunds to accounts
- Performed quality audits on paperwork, recorded all phone calls in the database, ensured profiles and charges are set up, and added brief and accurate notes in the patient account's comments section promptly after a check is generated and prepared for mailing.
Patient Account Rep
Healthcare Scouts (Temp Agency)
Manchester
10.2016 - 12.2016
- Verified accuracy of billing data and revised any errors
- Performed bookkeeping work, including posting data or keeping other records
- Operated typing, calculating, or billing criteria
- Answered mail or telephone inquiries regarding routing or procedures.
Patient Accounts Billing
K-Force Temp Agency (Southern New Hampshire Health)
Manchester
06.2016 - 08.2016
- Investigated, rectified, and rebilled claims electronically
- Reviewed, addressed, and evaluated created claim modifications in a timely, compliant, and consistent way
- Examined patient records to apply modifiers appropriately, address MUE, NCCI, and medical necessity edits, and collaborate with physician offices, coding, billing, and reimbursement resources to resolve edits
- Examined patient interactions to determine suitable combining costs for DRG and overlap billing regulations
- Thoroughly understood payer rules, Medicare PPS payment billing rules, revenue codes, and diagnosis codes for proper claim rule validation
- Worked with revenue cycle systems to update diagnosis, charge, or other pertinent information for claim submission
- Ensured pertinent documentation obtained is recorded in the EMR
- Kept abreast of all claim billing requirements, coding rules, government and local regulations, and payer rules.
Billing
Eastridge Temp Agency (Employer)
San Diego
10.2015 - 03.2016
- Verified insurance updated for members
- Called suppliers to confirm insurance details
- Updated providers for insurance reasons in the system
- Found data input problems and fixed them or notified supervisors of them.
Billing
Solomon Page Group (Employer)
San Diego
07.2015 - 10.2015
- Inserted data in designated data fields and read source documents such as billing updates, patient information updates, diagnosis code updates, etc
- Compiled, sorted, and ensured the accuracy of data before entering it
- Compared data with source documents or re-entered data in verification format to find errors
- Stored complete documents in appropriate locations
- Found and fixed data input errors or notified supervisors of them.
Claims Reconciliation
Medical Professionals (Employer)
San Diego
06.2015 - 08.2015
- Entered data about claims into databases, completed insurance claim forms or associated paperwork, and ensured they were accurate
- Calculated the amount of the claim
- Added or attached data to the claim file
- Filed claims for reimbursement or additional research
- Input medical claim data daily
- Reached personal and group objectives with few mistakes
- Complied with Medicare, Medicaid, and HIPAA compliance regulations
- Participated in instructional activities and attended staff meetings weekly
- Gathered and evaluated all documentation needed to determine eligibility
- Verified that billing data was accurate and fixed any errors
- Addressed discrepancies in accounting documents
- Created itemized bills, invoices, or statements, noting the amounts payable for supplies or services
- Utilized a calculator, billing device, adder, or keypad
- Posted notices opposing check payments to stop payments
- Reached the pinnacle of technical proficiency.
Customer Care Representative
Insight Global (Employer)
San Diego
02.2015 - 03.2015
- Answered questions about products and services, processed orders, closed accounts, and collected complaints from clients by phone or in person
- Kept track of all discussions and transactions with clients, including details about their queries, grievances, and comments, as well as the issues brought up by the clients
- Contacted clients to respond to inquiries, share information about impending changes, or report findings from a claim inquiry
- Determined the price for the services requested, collected money or deposits, or set up an invoice system.
Medical Collections A/R
Professional Staffing (Employer)
San Diego
11.2014 - 12.2014
- Used an accounting software-programmed computer to record, store, and analyze data
- Verified numbers, postings, and papers for accurate math, proper CPT/HCPS codes, and correct entry
- Categorized, documented, and condensed financial and numerical data to gather and maintain hospital claim financial records
- Utilized specialist software for professional claims, debit, credit, and total accounts are kept on computer programs and databases
- Used copy machines, typewriters, and 10-key calculators to do computations and create paperwork that would be mailed to insurance companies to be paid
- Deposited, tracked, and banked checks as well as coupons
- Complied with hospital claim-related financial, statistical, and accounting auditing reports and tables
- Handled receivables as well as profits and losses
- Coded documents in accordance with business protocols
- Reconciled or identified and reported any disparities discovered in medical records
- Read, comprehended, and adhered to written and spoken instructions
- Used a computer and standard office supplies
- Identified and fixed payer issues by contacting the payer's provider relations department or looking up the payer's website
- Assessed patient accounts to determine current insurance coverage
- Kept track of customer financial information and the progress of collection activities
- Found overdue accounts and informed clients via mail, phone, or in-person visits to request payment
- Used computers and various automated tools to locate and keep an eye on past-due debts
- Determined repayment plans or plans for debt repayment based on the financial circumstances of clients
- Informed clients of the steps and techniques required to pay off their debt.
Administrative Account Representative
Rose International
San Diego
10.2012 - 02.2013
- Updated member information into the program
- Managed National Accounts/Member Enrollments
- Protected the security of medical records and ensured confidentiality
- Identified and resolved customer service issues/requests or transferred to appropriate party advocate
- Responded to member/customer service, information or product membership reference materials, duplicate membership cards or stickers, etc
- Reviewed records for completeness, accuracy, and compliance with regulations.
Education
Current Student -
Manchester Community College
06.2025
Certificate of Completion - Medical Billing And Insurance
New Bridge College
El Cajon CA07.2011
GED -
Mid-City San Diego Continued Education
01.1992
Skills
- ICD-9-10
- HCPS
- CPT
- Medical Insurance Practices
- Good understanding of medical terminology
- Knowledge of medical coding ICD-10, CPT, HCPS
- Solid Knowledge of UB-04 and 1500 claims process
- Foundations/Epremis/Epic Programs/ Optima/ Ability/ Waystar
- Janis
- Centrix
- Availity
- EZ-Cap/EZ Net
- Passport
- Lazerfice
- XIFIN
- MRDE
- QNTX
- Marx
- Data CMSGOV website
- CAGOV Med-Cal Website
- NHGOV
- Massgov website
- NPPES
- Zotec
- EBC
- Medicare
- Medicaid
- Veterans Insurance
- Mass Insurance
- NH Insurance
- Collections Processing
- Electronic Health Records
- Strong Computer Skills
- Exceptional Customer Service
- Data Entry/Word/Excel/Outlook
- Programs IDX
- Cactus
- Sharp Net
- Med Access
- CalHers
- Bright Tree
- People Soft
- The HUB
- Intellis
- One Note
- DPA
- SIR2000
- LIS
Timeline
Remote Enrollment Specialist
Wipro Limited/Cigna
09.2023 - 12.2023
Call Center Representative
KNFT Staffing/Automated Health systems
06.2023 - 09.2023
Remote Enrollment Specialist
Wipro Limited/Cigna
09.2022 - 05.2023
Senior Healthcare
Guardian Angel
06.2022 - Current
Home Health Aide
Golden Heart
07.2021 - 06.2022
Case Manager Specialist
Collabera
03.2020 - 05.2020
Site Coordinator
Accountemps
10.2019 - 12.2019
Medical Billing
The Staffing Group (Temp Agency)
12.2018 - 02.2019
Ambulance Billing
KBW (Temp Agency)
12.2018 - 02.2019
Patient Account Representative
Accountemps (Catholic Medical Center)
09.2018 - 11.2018
Medical Claims Administrator
NuLife (Contego)
04.2017 - 04.2018
Patient Account Rep
Healthcare Scouts (Temp Agency)
10.2016 - 12.2016
Patient Accounts Billing
K-Force Temp Agency (Southern New Hampshire Health)
06.2016 - 08.2016
Billing
Eastridge Temp Agency (Employer)
10.2015 - 03.2016
Billing
Solomon Page Group (Employer)
07.2015 - 10.2015
Claims Reconciliation
Medical Professionals (Employer)
06.2015 - 08.2015
Customer Care Representative
Insight Global (Employer)
02.2015 - 03.2015
Medical Collections A/R
Professional Staffing (Employer)
11.2014 - 12.2014
Administrative Account Representative
Rose International
10.2012 - 02.2013
Current Student -
Manchester Community College
Certificate of Completion - Medical Billing And Insurance
New Bridge College
GED -
Mid-City San Diego Continued Education