• Manage a Book of Business of various Clients and representing the Integrated Accumulations Department for CVS/Caremark when working with the assigned Medical Partners/Vendors.• Responsible for overseeing the transactions shared between the Medical Partner and CVS/Caremark.• When transaction errors occur, responsible for resolving those errors either internally or with the help of the Medical Partner to ensure accuracy.• In resolving the transaction errors required investigation and researching the source of the error and correct it by using the Department’s standard processes and tools. It may also require partnering across work streams with other internal resources to ensure the errors are corrected in a timely and efficient manner. This includes representing the Integrated Accumulations Department on cross-functional work teams to resolve specific client issues.• Lead Consultant on implementing new Medical Integrators and Clients through detailed Project Plans. Ensure proper configuration of transactions within the Project Plan Timeline to meet Medical Integrators and Client Go-live, conducting Functional Testing of Medical and Rx Claims, and ensuring lines of communication are open throughout the Project to completion with Medical Integrators and Internal Departments.• Possess a broad business acumen, strong relationship building and relationship management, tenacity to find root causes in any problem, and strong independent work management skills. • Work with cross-functional departments to collaboratively build efficient and effective teams.• Lead in weekly/quarterly conference calls to maintain issues or resolve issues between CVS/Caremark and the Medical Integrator.• Mentor and Point-of-Contact for helping to answer questions from Peers.• Stand as a Lead Trainer for department policies and procedures and train new hires to develop and learning resources and services. • Updates and maintains Job Aides for work related issues on a continual basis.

•Performs weekly work queue assignments. Systematically analyze and audit for any overpayments and apply billing rules to determine appropriate party to refund.•Appropriately research misapplied, undistributed, incentive payments and distribute or undistributed, contractual adjustments or request refunds for various types of payers.•Based on interpretation of the EOB (Explanation of Benefits), appropriately posts and/or reverse contractual adjustments or allowances. Determine any system errors and submit to Manager.•Process correspondence for assigned accounts and take appropriate action.•Receive patient inquiries regarding status of refunds, using good judgment in interpreting questions, educating and resolving issues as professionally as possible.•Research and analyze status of insurance refunds and communicate professionally with insurance companies regarding status of requests, paid/pending claims and the rebilling of unpaid claims.•Determines and submits appropriate documentation for refund approvals and follows guidelines as outlined in FPBO policies and procedures or instructions provided.•Ensure that registration data is accurate and updated; utilizing all available data resources as determined by FPBO and transfer any claims that require charge corrections to the assigned party.•Through careful research and interpretation, determines financial responsibility of refund balance.•Works rejected refund requests on a daily basis.

•Provide timely and accurate Physician Billing in support of Loma Linda University Faculty Practice Plan and provide services to over 600 caregivers, which include coding, charge entry, billing, and collections. •Assist in the support of clinician services by producing a stable, competitive, financially viable billing service by maintaining quality and cost-effective flexible programs and services. •Using the Epic operating system, daily duties are to focus on the Revenue Cycle analytics which includes Accounts Receivable, Coding, Revenue Recovery, Radiology, Radiation Medicine, Surgery, Remittance, Credit and Batch, Client Services, Self-Pay, Billing, Government, Charge Posting, and Authorizations.•Lead and assist in Project Management assignments as directed by the Director of Operations. •Provide support for CSM’s (Client Service Managers) by creating Agendas for Physician/Group Administration meetings that are held quarterly/monthly.•Work with the Credit department analyzing patient accounts that have credits. Use working knowledge of all insurance types and their guidelines including the ability to read and interpret EOB’s (Explanation of Benefits).•Run trending reports to proactively capture problem areas with reporting, billing, charge capture, adjustment codes and account receivables.•Manage projects with Director of Operations to streamline efficiency. Attend Manager Meetings as appointed by Director of Operations.•Rotate with Managers of each department to identify Best Practices and work on Process Improvement projects that will positively impact each department.

Ensure student have a point of contact to answer questions, look at class schedule and walk with the student through the first day of class until graduation.

Ensured that timely delivery of finished product arrived at the various wareshouses in various locations acorss the United States.

Provided customer service to Home Depot customers in regards to delivery setup, product information, damage resulotuion and product replacement.