Jolynne Carleton Email & Phone Number

Shakopee, MN, US

Plymouth, MN

Plymouth, MN

Plymouth, MN

Responsible for the adjudication of physician and hospital claimsFollow state guidelines when making a determination of payment or denial of claimAssist in updating policies and proceduresMentored employees with claim questionsMaintain a Quality Standard of 100% and Financial Accuracy of 99.76%

Golden Valley, MN

Adjudicate hospital and physician claims according to member benefits and provider contractsInvestigate and follow up on accident and pre-existing claimsCalculate coordination of benefits Respond to internal inquiries regarding claim paymentsConsistently maintained a 99.5% accuracy score

Minnetonka MN

Interpreted Medicare LDC/NCD policies against claim platform set upIdentified gaps in set up to eliminate future payment errors Created and managed timelines for each policy correctionImplemented and trained new policies and procedures with claim staffPerform audit of claim system project is complete

Minnetonka MN

Responsible for Commercial, Medicare, and Medicaid claim adjudicationCreated and maintained complex editing functionality of claims platformReduced manual policies and procedures by 10% creating auto-adjudication of claims.Identified and resolved complex claims processing errorsProvided training to new employees and mentored current team membersResponsible.

Minnetonka, MN

Responsible for system set up of member benefits, Explanation of benefits, Provider Remits, claim editsConsistently maintained 98% accuracy in adjusting hospital and physician claimsProvided exceptional customer service to internal and external customersQuickly resolved complex claims issues to drive member satisfaction and improve adjustment turnaround.

Medical Coding

Activities and Societies: AAPC

Certfiicate

Received training for ICD-9 coding, CPT coding, and Medical Terminology

High School Diploma