Vanessa Carter

Work History

Associate Software Engineer

United Healthcare Group

07.2016 - Current

Diagnosed, troubleshot and resolved network and system problems.
Gathered requirements and performed gap analysis through design workshops with users.
Tested troubleshooting methods and documented resolutions for inclusion in knowledge base for support team use.
Designed and implemented scalable applications for data extraction and analysis.
Designed and developed forward-thinking systems that meet user needs and improve productivity.
Conducted performance testing.
Collaborated with cross-functional teams to develop, test, and deploy high-quality software solutions for clients.
Utilized version control tools such as Git .
Created successful test scripts to manage automated feature testing,
Maintained accurate documentation of code changes, ensuring smooth handoffs between team members.
Participated in sprint planning sessions and follow a detailed Go-Live plan for each upgrade for my markets.
Communicated effectively with stakeholders throughout all phases of project life cycle. As part of meetings to update and discuss further requirements.
Analyzed work to generate logic for new systems, procedures and tests.
Tested functional compliance of company products.
Managed time efficiently in order to complete all tasks within deadlines.
Applied effective time management techniques to meet tight deadlines.
Demonstrated respect, friendliness and willingness to help wherever needed.

Billing and Collection Specialist

Patient Care Infusion/Arizona Home Care

02.2016 - 07.2016

Streamlined collection processes for increased efficiency and faster payments through consistent follow-up with clients.
Achieved higher recovery rates through diligent research and investigation of disputed invoices, ultimately reaching successful resolutions for both parties involved.
Processed and verified invoices to secure accuracy of billing information.
Provided clear documentation to support all collection efforts, allowing for easy reference in case of disputes.
Developed and maintained billing procedures to make timely payments.
Home Infusion billing to all payer sources such as Medicare, Medicaid, Commercial, Workmen's Comp and Market Place plans utilizing CPR+ (Certified Professional Reimbursement).
Initiate appeals on denials or rejections when correction is not appropriate. Compile analysis on procedures followed to substantiate billing and collect data and documentation for appeal cases.
Facilitate joint operations between pharmacy, intake, authorization department and General Home Care department to ensure services are rendered appropriately and billing accurately reflects services performed.
New hire training on processes and procedures and developing standardized documentation for employees to follow.

Reimbursement Coordinator

Sirona Infusion

09.2014 - 02.2016

Assisted in negotiating favorable contract terms with insurance companies, contributing to improved financial outcomes for the organization.
Employed clinical and billing codes expertise to correct billing inconsistencies.
Created documents in accordance with payer guidelines and submitted to appropriate parties.
Billed and collected for claims submitted.
Reduced billing errors by implementing a thorough review process, resulting in increased efficiency and accuracy.
Ensured timely payments for clients through diligent monitoring and follow-up on outstanding claims.
Implemented and maintained electronic claims submission systems, reducing paper waste and improving processing efficiency.
Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
Followed up on denied and unpaid claims to resolve problems and obtain payments.
Prevented delays and claim denials by correcting information prior to submission.
Contributed to successful appeals efforts by compiling necessary documentation and presenting persuasive arguments on behalf of patients or providers seeking coverage reconsideration from insurers.

Medical Claims Specialist-Account Clerk

Pinal/Gila Long Term Care

08.2001 - 10.2011

Paid or denied medical claims based upon established claims processing criteria.
Maintained confidentiality of patient finances, records, and health statuses.
Responded to correspondence from insurance companies. Accurately reading COB's.
Reviewed provider coding information to report services and verify correctness.
Evaluated medical claims for accuracy and completeness and researched missing data.
Identified and resolved discrepancies between patient information and claims data.
Determined appropriateness of payers to protect organization and minimize risk.
Processed medical claims performed analysis on complex scenarios for adjustment. Adjudicated Institutional and Professional claims in Plexis database system in timely manner in accordance to AHCCCS guidelines.
Compile analysis on pended Encounters and perform updates in AHCCCS State database (PMMIS) resulting in reduction of sanction payments, pended encounters and increase in acceptance rates and overall financial completeness.
Balanced adjudicated claims and produced EOB’s for payment to providers in excess of up to1 million dollars weekly. Completed audits on all payables submitted to finance department. Develop policies and procedures to improve work processes.
Cross trained new employees.
Submitted electronic/paper claims documentation for timely filing.
Communicated effectively with staff members of operations, finance and clinical departments.
Effectively resolved claim disputes by conducting thorough investigations and presenting findings.
Managed large volume of medical claims on daily basis.
Researched and resolved complex medical claims issues to support timely processing.
Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.
Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Skillfully navigated Medicare/Medicaid regulations in order to secure maximum reimbursement rates for qualifying services provided.
Resubmitted claims after editing or denial.
Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
Processed insurance payments and maintained accurate documentation of payments.
Made contact with insurance carriers to discuss policies and individual patient benefits.
Calculated adjustments, premiums and refunds.
Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
Monitored and updated claims status in claims processing system.
Generated, posted and attached information to claim files.
Self-motivated, with a strong sense of personal responsibility.
Passionate about learning and committed to continual improvement.
Gained extensive knowledge in data entry, analysis and reporting.
Used critical thinking to break down problems, evaluate solutions and make decisions.
Reconciled system accounts against bank statements.

Summary

Overview

Work History

Associate Software Engineer

Billing and Collection Specialist

Reimbursement Coordinator

Medical Claims Specialist-Account Clerk

Education

Associate of Science - Accounting

Associate of Science - Accounting

Associate of Science - Billing And Coding

Skills

Timeline

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