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Click here or scroll down to respond to this candidateCandidate's Name
Manager Medical Claim Analyst/AdjudicatorDriving license TEStreet Address 0Manager Medical Claim Analyst/Adjudicator with extensive Street Address
record in Medicaid DME supply claims adjudication across multiple: . : PHONE NUMBER AVAILABLEstates. Expert in leveraging data analytics for process enhancements andmaintaining rigorous compliance with Medicare and Medicaid regulations. EMAIL AVAILABLEProven leader in developing training programs that elevate teamperformance and optimize claims processesEmployment historyLead Medicare Part B/Medicaid Adjudicator Sep-20/2'- PresentCVS/Omnicare at Dayton, OH-WFH+ Managed billing for Medicaid DME supply claims for multiple states+ Utilized external Medicaid portals for claims submission+ Specialized in Long Term Care Billing+ Utilize data analytics tools to identify trends and patterns in Medicare Part B/Medicaid claims processing, and providerecommendations for process improvements to enhance efficiency and accuracy+ Develop and maintain relationships with Medicaid and Medicare agencies to stay updated on changes in regulations and policies,ensuring compliance and maximizing reimbursement opportunities for CVS/Omnicare+ Implement training programs to educate team members on the latest updates and changes in Medicare Part B and Medicaidregulations, ensuring compliance and efficiency in claims processing+ Lead cross-functional teams to streamline the Medicare Part B/Medicaid claims adjudication process, ensuring timely andaccurate processing while maximizing reimbursement opportunities for CVS/Omnicare+ Collaborate with cross-functional teams to identify opportunities for process improvement and streamline communicationbetween departments to enhance overall efficiency in Medicare Part B and Medicaid claims adjudication for CVS/Omnicare* Collaborate with the IT department to identify and implement technological solutions that streamline Medicare Part B/Medicaidclaims adjudication processes, increasing efficiency and accuracy for CVS/Omnicare+ Learned and managed third party hard copy billing for paper claim billing+ Negotiating claim window reopening for resubmission for maximum reimbursement+ Develop and implement quality assurance processes to ensure that Medicare Part B and Medicaid claims are accurately processedand comply with all regulatory requirements, reducing errors and maximizing reimbursement opportunities for CVS/Omnicare+ Develop and implement strategies to proactively identify and address potential compliance issues in Medicare Part B/Medicaidclaims processing, ensuring adherence to regulations and minimizing risks for CVS/Omnicare+ Analyze and assess the impact of upcoming changes in Medicaid and Medicare regulations on claims processing, and providerecommendations to proactively adjust processes and strategies to maintain compliance and maximize reimbursementopportunities for CVS/Omnicare+ Lead the implementation of a continuous improvement culture within the Medicare Part B/Medicaid adjudication team atCVs/Omnicare, encouraging team members to actively participate in identifying inefficiencies, proposing solutions, andimplementing process enhancements to optimize claims processing efficiency and accuracy |
