Carlene DeKenipp

Medical Billing Specialist with experience supporting busy optometry/ophthalmology clinics, medical practices, and hospital systems. Skilled in medical billing, insurance verification, claims processing, ICD-10-CM and CPT coding, and denial management. Experienced in distinguishing vision plans from medical insurance, applying procedure-specific modifiers, and resolving complex billing issues.

Strong attention to detail, commitment to accuracy, and ability to adapt quickly to new billing software and workflows.

Willing to relocate: Anywhere | Work authorization: Authorized to work in the United States for any employer

Medical Billing Specialist at Total Eyecare (2026-06 – Present)

• Manage billing operations for a busy optometry/ophthalmology clinic, processing claims for comprehensive eye exams, diagnostic testing, and surgical procedures.
• Differentiate routine vision plans, including VSP and EyeMed, from medical insurance plans, including Medicare and BCBS, to ensure accurate code selection and reduce claim rejections.
• Apply eye-care-specific modifiers, including RT, LT, 25, and 59, for unilateral procedures and same-day minor surgeries, maintaining a clean claim rate above 95%.
• Investigate and appeal denied claims, recovering thousands of dollars in delayed revenue by correcting laterality requirements and updating ICD-10-CM diagnosis pointers.
• Verify patient eligibility and insurance benefits before appointments, helping reduce billing inquiries and point-of-service errors.

Medical Billing Specialist at Amira Integrative Health (2023-09 – 2024-07)

• Reduced medical billing errors through detailed patient record reviews and accurate coding.
• Improved revenue collection by following up on unpaid claims and insurance denials.
• Streamlined billing workflows by implementing efficient processes and utilizing billing software.
• Increased billing department efficiency by auditing internal procedures and recommending improvements.
• Ensured timely submission of claims to insurance carriers, supporting prompt reimbursement for services rendered.
• Maintained effective communication with healthcare providers regarding billing-related matters.
• Assisted patients with understanding medical bills and resolving complex insurance questions.

Medical Receptionist at Pocono Ear, Nose & Throat (2021-08 – 2023-05)

• Managed front desk operations and responded to patient inquiries in a timely and professional manner.
• Coordinated appointment scheduling to improve patient flow and reduce wait times.
• Updated patient records and verified insurance coverage to maintain accurate information.
• Protected patient confidentiality and followed HIPAA regulations and medical office policies.

ER Registration Representative at Lehigh Valley Health Network (2020-11 – 2021-08)

• Registered patients and verified insurance information for emergency department visits.
• Improved check-in workflows to help reduce registration wait times.
• Entered patient demographics, insurance information, and medical data accurately.
• Maintained confidentiality while handling sensitive personal and financial information.
• Verified insurance coverage and obtained necessary authorizations to help reduce billing errors.

Certification in Medical Billing & Coding – Suffolk County Community College (2012-06 – 2012-08)

High School Diploma – Longwood High School (2000-09 – 2004-06)