⦁ Provide networking/ desktop support and perform mainframe and account maintenance tasks. Troubleshooting Cisco and Citrix
⦁ Ability to work independently
⦁ Attention to quality and accuracy
⦁ Ability to juggle multiple tasks and priorities

• QXNT, NextGen, Diamond, Intergy, Navicure, Cerner, EOB1, Facets.

Conduct insurance verification checks by calling Insurance Companies to verify status of Patients as in their Effective date, Pre-authorization, Term date, Deductible and Out of Pocket Costs, Schedule patient procedures, Obtain Patient precertification, Generate new patient accounts, Verify Patient information in Facets with information from image viewer. Working Medical, vision and dental claims. Review and abstract medical records. Review claims in Facets to determine true appeals. Posting checks to Patient accounts, proofread transcribed medical documents and conducted quality checks, Transmitting claims electronically and correcting claims, override payments, Auditing claims and charts, Processing Medical, Vision and Dental paper claims in Facets. Processing Workers Comp claims along with pulling Patient medical records for each claim. Posting payments. Adjudicated medical and dental claims.

• Processing Patient Insurance denials and rejections, Working Explanation of benefits (EOB), Obtaining authorization for Patients to receive care, Assisting Patients with past due balances, Filing Reconsiderations and Appeals for follow up Claims, entering date stamped received Claims in Focus, Facets and TriZetto, Adjudicate claims. Meeting quotas by working on New and Aged Patient accounts daily. Follow up on Workers Comp claims by contacting adjusters, work through payment issues, documenting notes on accounts in database with updates on cases.

• Blue Cross, Aetna, Medicare/Medicaid, Medi-Cal, Patient Care Infusion IV, Cigna, Humana, United Health Care, Workers Comp, Home Health, Hospice, TriCare for Life, Assist Providers with interpreting Member eligibility and benefit information, answering utilization management questions, Running test claims for Medicare Part D, Data entry, Handling claims status inquiries and processing claims using QXNT, NextGen, Diamond,

• Performs A/R collections and billing and assigned special projects. Verify that patient services are coded correctly and payment has been applied properly. Analyze and audit accounts and claims for the correct balance, proper follow-up and complete reimbursement

• Monitor collection issues and resolves with payer. Processed by phone as well as on-line inquiries and paper claims correspondence taking appropriate collection actions that included: working rejections/denials, calling for status, tracer claims and rebilling.

• Team lead responsible for filing and tracking claims and informing Patients and Providers of claim status. Identify misapplied payments and requests payments, adjustments/transfers or refunds

• Managed patient accounts and matched with corresponding transcribed reports, proofread documents for spelling and grammar mistakes, update patient data in Medical system database, Check Patient information in TriZetto, QNXT, Mainframe, Mail order, Care Source, People Safe, Phxlinks, Med MC, Care Radius as well as monitor overdue accounts, Submitting QC paper claims, receive payments and post amounts paid to patient accounts. Processing Medical, dental and vision claims. Notify Patient by mail that services requested by doctor were denied. Processing and writing denial letters to patients and doctors.

• Inland Empire Health Plan, Kaiser, Blue Cross, American Health, Home Health/Hospice, Worker Comp, Beech Street, UMR, Unions, Medicare Part D. Review, correcting and processing claims as well as processing and approving prior authorization referrals prior to patient services.