Katherine Carter Email & Phone Number

Colorado Springs, CO, US

Chicago, Illinois, US

• Resolve underpayments & overpayments to ensure claim was paid correctly.
• Follow up on all denials, underpayments, and no response claims for our hospital facilities.
• Create Provider Disputes with contract language to overturn denials.
• Review payer issues / trends, system errors impacting workflows and escalate to management as necessary.
• Utilize Epic hospital billing resolute for documentation, reroute accounts to other departments, and submit corrected claims.
• Reduce aging accounts by 10% by obtaining updated insurance information and escalating claims for payment.

Chicago, Illinois, US

• Handled medical claims with 90% or more accuracy.
• Reduced aging accounts by 10% by obtaining updated insurance information and escalating claims for payment.
• Assessed itemized statements and UB04s to identify billing errors for possible correction.
• Knowledge to identify when claims should be appealed with qualifying denials.
• Established trends with claims that were denied repeatedly in error and added to IPO for team review.
• Submitted medical records, itemized statements, or sterilization forms for claims to process.

Frisco, Texas, US

• Identified and escalated trends to management for claims that were denied repeatedly in error.
• Handled medical claims with 90% or more accuracy.
• Researched and identified coding errors for MUE, NCCI edits, or POA indicators by utilizing CMS.gov’s website before escalating for correction.
• Appealed claims by providing medical records, itemized statements, or sterilization forms for claims to reprocess for payment.
• Submitted corrected claim with valid authorization when original claim lacked info.
• Submitted bulk accounts to insurance companies for reprocessing of incorrectly denied claims that resulted in clearing underpayment discrepancies.

Sunrise, Florida, US

• Underpayment Analyst –
• Validated underpayment discrepancies with reason codes for un-coded inventory.
• Pursued additional payment from UHC for all underpayment discrepancies.
• Resolved underpayment discrepancies through I-plan changes that updated expected reimbursement.
• Identified coding errors for MUE, NCCI edits, or POA indicators and escalated to Revenue Integrity and HIM for corrections to rebill corrected claim.
• Applied correct rate schedule based on contract and bill type of claim to resolve incorrect underpayment discrepancy.

Centennial, Colorado, US

• Prioritized projects to bill claims to Medicare in a timely manner.
• Obtained patient’s Medicare information via HIQA to verify or update accounts.
• Resolved account issues using Epic’s UB editor to bill clean claims to Medicare.
• Escalated accounts to management appropriately to help with trends.
• Adhered to all policies and procedures when adding and removing modifiers from codes.
• Utilized CMS.gov to identify coding errors for possible MUE, NCCI edits, or POA indicators and escalated to Revenue Integrity for correction.

Woonsocket, Rhode Island, US

• Managed assigned pharmacy workstations and tasks to support the team’s ability to fill patient prescriptions promptly, safely, and accurately according to policy.
• Knowledge of different condor codes for pharmacy insurance.
• Knowledge of medications uses and possible side effects.
• Assisted customers with understanding prescription pricing, picking up prescriptions, dropping off new prescriptions, scheduling refills, and updating insurance.
• Received recognition from CVS headquarters due to raving reviews from patients about above and beyond care provided to patients.

Sunrise, Florida, US

• Top/High Dollar Collections Specialist -
• Assessed itemized statements and UB04s to identify billing errors for possible correction.
• Worked overdue accounts for escalation for faster processing by insurance company.
• Escalated bulk accounts to management to trend insurance companies back log.
• Knowledge to identify when claims should be appealed with qualifying denials.
• Established trends with claims that were denied repeatedly in error.