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PHONE NUMBER AVAILABLE EMAIL AVAILABLEProactive Team Player and ReliableProfessional Experience:Verida Claims Auditor April 18, 2023 to currentConduct audits and reviews of claims. Document the findings and recommendations.Request all information from internal or outside sources to ascertain completeness and validity of claims.Analyze claim trends to determine any necessary refinement of business rules and workflows in order to improve the overall claims process.Contribute to the development of claims analysis reports.Research claims as needed.Verida Claims Specialist I October 17, 2022- to April 18, 2023 Correlate the reimbursement request forms and resubmissions by provider per day in chronological order. Approval and denial claims for reimbursement and resubmissions. Responsible for generating and distributing copies of denied reimbursement request to providers. Filing all reimbursement forms. Assisting with special rates from the Call Center. Relays instructions, messages and other information as requested from the management team. Maintains a current working knowledge of all company policies, procedures, rules, regulations and memorandums. Responsible and accountable for updating management on changes and/or extraordinary circumstances affecting the company and/or transportation provider. Other duties as assigned by management teamModivcare - Service Expert Specialist II - 2021-2022Records and initiates investigation of complaints, grievances and general issues via phone and all incoming communication channelsInitiates corrective actionsWork closely with other work streams to complete investigationCollects all necessary supporting information to accurately provide a resolutionMonitors the complaint aging report in order to comply with turnaround requirements on resolutionModivcare Transportation Customer Advocate 2012-2015 and 2020-2021Schedule route and dispatch trips to all manner of providersAssist in coordinCommunicate with transportation providers when applicableIdentify and resolve problems with transportation provider billing invoice formsMeet all departmental deadlinesWork closely with the Fraud and Abuse departmentation of mass transportation when neededAdminister trips for volunteer/ independent drivers and mileage reimbursement programCompletes all documentation and process task associated to mileage mapping and application procedures if responsible for volunteer/ independent drivers and mileage reimbursement programsWorks closely with transportation providers and health care facilities to resolve problemsAssigns reservations to network providers to ensure that vehicle resources are used most efficiently and effectively to meet client demandResponsible for daily communication with transportation providersEnsures accurate trip data inputOther duties as assigned.Modivcare - Claims Processor 2015-2020Communicate with transportation providers when applicableIdentify and resolve problems with transportation provider billing invoice formsMeet all departmental deadlinesWork closely with the Fraud and Abuse departmentModivcare - Customer Service Representative - Jan 2012Receives and documents customer concerns while ensuring all relevant information is correctAdheres to and ensures all company policies and proceduresMaintains an acceptable attendance and tardiness recordEnsures accurate trip data inputDemonstrates personal commitment to producing high quality workRefers unresolved customer grievances to designated department for further investigation and resolutionEducation: Diploma Northmont Senior High School |
