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Click here or scroll down to respond to this candidateCandidate's Name
Street Address HIGHLAND DR.BIRMINGHAM, ALA Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEEDUCATIONAIU University 2010 2011Chicago, IL.Healthcare ManagementC.A. Freds Tech School 1976 - 1977Tuscaloosa, Ala.BusinessLew Wallace High 1972 - 1976Gary, Ind.AcademicsEXPERIENCEViva Health 2011 - 2019Birmingham, Ala.Q.A. SpecialistTrains/reviews Commercial, Medicare and Drummond claim staff to include entry/adjudication for accuracy based on Viva Healths Certificates of Coverage, regulatory/compliance guidelines, all Policies and Procedures. Documents and distributes error findings to Claims Supervisor for review and to educate staff on claims payments issues. Reconcile/provides bi-weekly and monthly quality assurance summaries to include individual and departmental errors, claims productions and other findings. Investigates claim submissions for coding inaccuracies and provide feedback to CFO to help with overall cost savings. Maintain confidentiality in regards to individual error results.Benefits Configuration, test newly implemented benefit packages prior to going live to ensure all benefits, deductibles, co-payments and co-insurances are applying correctlyViva Health 1998 2011Birmingham Ala.Claims AdjusterProvide customer service to providers and members concerning claimsreview paper claims, HCFAs and UB92 for accuracy in entering data,for claim types, CPT-4, ICD-9, HCPCS codes and provider information beforeprocessing claims for payments or denials, Review electronic claims for accuracy in member demographics, REVENUE, ICD-9 and CPT codes before making payments or denials, co-ordinate benefits with Medicare, Medicaid and other insurance companies, maintain departmental production and quality goals, follow up and research pended claims to assure the turn-around time frames are met, read, understand and apply appropriate claims policies and procedures that relate to the adjudication of claims.Strategic, Inc 1997 - 1998Birmingham, AlaClaims AdjusterReview all provider claims, HCFAs and UB92, process for payments, review checks before mailing to providersMedPartners 1995 - 1997Birmingham, AlaCustomer Service/Insurance F/UReview ledger, find all accounts 15 30 days old, call insurance companies orpatients to request payments, print and file HCFA or UB92Lloyd Noland Hospital 1993 - 1995Birmingham, Ala.Patient Accts. RepReview account ledger for unpaid balances, call providers or patients to collectpayments, mail collections or promissory letters to patients, pull medical records and mail to insurance companies as requestedProvident Life 1979 - 1992Birmingham, Ala.Claims AdjusterProvide customer service to providers and members, process claims for payments ordenials, mail out letters to request info about accidents, workmans comp, coband subrogationSKILLS Customer Service, Medical Terminology, Coding Workshop, Microsoft Word,AS 400, Typing, Faxing, Adding Machine, CopierREFERENCES AVAILABLE UPON REQUEST |
