CARLA BEVERLY LAKE

146 Harbin Drive

Dallas, Georgia 30132
cl7aca76@westpost.net
Cellular: 770-354-3186
Home: 770-505-8830

PROFILE
Highly qualified Medical Insurance Reimbursement and Account Management Professi
onal with over fifteen years in the Healthcare Industry including emphasis on Pa
tient Services.
Highly motivated and enthusiastic self-starter and team player with proven busin
ess acumen, strong work ethic, excellent communication and negotiation skills an
d career-long commitment to the highest service and quality standards.
Frequent recipient of Awards for Outstanding Performance.

EXPERIENCE
Medical Case Management/Patient Services: Experience with HMOs, PPOs, Indemnity,
POS, private pay, TPA, W/C, A/A, Medicare, Medicaid, managed care, military and
government benefit plan accounts ... analyzing and resolving complex claims and
payment inquiries ... medical coding, billing and collections ... pre-certifica
tion of patients ... reviewing charges, payments, and reimbursements, and prepar
ing, processing and submitting insurance claims (paper and electronic) ... estab
lishing and maintaining excellent provider, vendor, referral source and Utilizat
ion Management relations ... assisting in compliance audits for AHCA and accredi
ting agencies ... analyzing provider performance and other medical/utilization d
ata ... experience with ancillary services and managed care ... maintaining and
reviewing confidential patient records ... full knowledge of medical terminology
... cultivating positive relations with medical personnel, support staff and pa
tients ...

EMPLOYMENT HISTORY

2009 - 2010
Breast Care Specialists, LLC, Atlanta, Georgia
MRI COORDINATOR
Managed MRI services and procedures for busy clinic in support of up to seven ph
ysicians performing MRIs and other medical services for up to 200 patients every
day. Personally worked with twenty-four to forty patients daily. Scheduled MRI
appointments, coordinated and remedied clinical and radiology screening issues,
and obtained lab results for clinic staff. Also obtained authorizations, perform
ed precertifications, and verified benefits from all health plans for diagnostic
imaging outpatient procedures. In addition, assisted Billing Department with in
surance appeals and coordinated real-time physician orders.
Efficiently and effectively managed high call volume utilizing excellent phone e
tiquette and communication skills.
1999 - 2008
Ambient Healthcare of Georgia, Inc., Atlanta, Georgia
[Formerly CuraScript; Integrity Healthcare & Gentiva Health Services]
ACCOUNT MANAGER (03-08)
Retained through transitions to seven different corporate owners. Served as on-s
ite hospital liaison, met with patients and coordinated infusion services. Respo
nsibilities included developing marketing plans and achieving budget, sales and
profitability goals consistent with business strategy. Called on private physici
ans, home health agencies, managed care organizations, clinics and hospitals. De
livered effective sales presentations tailored to client needs. Coordinated home
care at key hospitals. Cultivated and built strong client relationships with re
ferral sources, including clinicians, case managers, discharge planners, social
workers, physicians and drug manufacturer representatives.
Contributed to overall branch growth from annual gross of $990,000 to $4 million
in three years and achieved 94% of first year and 100% of second year budget.
Achieved branch record sales of Synagis Program (Disease Prevention), triaged ne
w referrals and developed real-time tracking report from referral intakes throug
h start of care.
Managed transition of patients to alternate site facilities or providers if requ
ired by health plan. Positioned pediatric home health agency to administer 94% o
f Medicaid patients, protecting revenues, profit margins and expenses.
SENIOR REIMBURSEMENT SPECIALIST (99-03)
Managed verifications, authorizations, and ICD-9/CPT/HCPCS coding. Submitted shi
p-verified claims and coordinated billing and collections for Medicare, Medicaid
and all health plans. Established and maintained strong relationships with key
decision-makers. Initiated contract leads for referral to sales team. Coordinate
d FFS rate negotiations. Monitored therapy trends and profit margins on all paye
rs.
Decreased DSO from 180 to 95 days within six months (GHS).
Best branch cash flow company-wide with DSO 78 days (AHC).

1996 - 1999
Matria Healthcare, Inc. - Corporate Office, Marietta, Georgia
TEAM LEADER / SENIOR VERIFICATIONS SPECIALIST
Supervised staff of five in the West Coast Region, with responsibility for verif
ying eligibility and benefits, and obtaining approvals from payer sources on beh
alf of patients requiring diabetic management, pre-term labor management and spe
cialized home infusion services. Triaged and assigned referrals to team members,
coordinated training for new and ongoing staff, and monitored staff productivit
y and efficiency. Also responsible for daily quality assurance reviews, coding a
nd documentation.
Increased approvals by 18% and decreased denials by 7%.
Successfully obtained extra-contractual benefits, out of network rate negotiatio
ns and approvals.

1992 - 1996
Central Health Services, Atlanta, Georgia
SENIOR ACCOUNTS RECEIVABLE SPECIALIST (HOME HEALTH CARE)
Managed verifications, authorizations, billing and collections, posted EOB payme
nts and supervised month-end accounting processes.
Successfully filed insurance appeals and overturned denials.
Initiated policy change to set standard for negotiating FFS rates.

Additional:
Patient Services Consultant with Altus Healthcare and Hospice; Seven years as a
Credit/Insurance Specialist ...

EDUCATION
Integrity Healthcare Sales Development Training (03-04)
Certificate in Business Technology [A.A. Equivalent], 1989
Balin Institute of Technology, Atlanta, Georgia
College Studies: Accounting, Computer Technology, Interpersonal Communications (
University of the U.S. Virgin Islands, GPA 3.90) ...

COMPUTER SKILLS
Microsoft Office; Mainframe and Database Management Systems ...