Carrie Sengdara
Murfreesboro
Summary
Experienced with revenue cycle processes, including billing and claims management. Utilizes analytical skills to identify and resolve discrepancies efficiently. Track record of effective communication and collaboration to enhance financial performance.
Overview
17
17
years of professional experience
Work History
Quality of Care Oversight Analyst
BlueCare
07.2021 - Current
- Analyzing system inquiries, claims, utilization management and health notes, as well as members benefits
- Assist in training new contractors to ensure cases are loaded and appropriate documents are saved in folders
- Researching and investigating the grievance or quality of care concerns; documenting the substance, action taken, and ensuring any required follow-up steps are taken
- Manage Reportable Event Management inbox; evenly distribute new cases to load amongst analysts, research follow-ups emails received to distribute to analyst assigned
Recovery/Resolution Analyst
Optum
03.2018 - 07.2021
- Understand and interpret policy/contract regarding claims auditing claims while working independently to identify and secure payer refunds
- Apply detailed of understanding various reimbursement methodologies
- Works claims utilizing a broad range of collection strategies including, phone calls, rebilling, etc
Payment Compliance Analyst
CHS
10.2016 - 03.2018
- Interpret contract reimbursement and provide feedback to management staff as required
- Manage overpayment/underpayment appeals, account follow-up and payor relationships
- Investigate and resolve overpayments on all claim types, as well as assist in recovery and resolution for health plans, commercial customers, and government entities as needed
- Review EOBs and ensure allowances, adjustments, unallocated payments, and overpayments are posted correctly
Lien Analyst
Professional Account Services, INC
01.2008 - 10.2016
- Followed up with guarantor for missing information to resolve billing issue, filed lien as needed
Health Insurance Analyst
Professional Account Services, INC
01.2008 - 10.2016
- Assured compliance with all hospital regulatory policies and procedures while auditing claims for processing errors
Education
Diploma -
Maplewood High School
05-2004
Skills
- Time management
- Critical Thinking
- Analytical thinking
- Microsoft Office Suite
- Customer Service
- Data Entry
- Comply with state/federal regulations and adhere to HIPAA and PHI guidelines
- Compliance analysis
Timeline
Quality of Care Oversight Analyst
BlueCare
07.2021 - Current
Recovery/Resolution Analyst
Optum
03.2018 - 07.2021
Payment Compliance Analyst
CHS
10.2016 - 03.2018
Lien Analyst
Professional Account Services, INC
01.2008 - 10.2016
Health Insurance Analyst
Professional Account Services, INC
01.2008 - 10.2016
Diploma -
Maplewood High School
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