Issue Participant invoices and process Participant Payments received.Review various weekly claims reports for missing informationReview various CMS reports issued on a daily and monthly basis and take action as neededPoint of Contact with various vendors regarding claims processing, enrollment submission, and Accounts Receivable itemsReconcile AR Aging on a monthly basisMaintain contract information with ProvidersPerform monthly census audits between systemsGenerate additional reports as requested by Executive Director

Supervised 9 Enrollment Specialists and trained New Enrollment Specialists• Assist Enrollment Specialists on Issues• Provide Training for Clients• Assist in New Client Implementation• Collaborates on system enhancements• Maintains data accuracy across 3 platformsProvides coverage for Specialist absences, typical duties include:• Review for any Enrollment problems that arise with our client's participants• Retrieve and post payments every month from PACE Participants• Reconcile A/R and Review the Aged A/R for each client, address any Discrepancies• Download Monthly Reports issued by CMS and distribute to clients• Download and Review Daily Report issued by CMS for any changes or updates to the client's participants• Provide documentation for our clients to Attest they are receiving the correct payment from Medicare each month • Complete and Submit a Monthly Audit of Enrollments submitted for each client to CMS• Work with CMS' Regional Office Account Managers and Third Party Contractor to resolve any Enrollmen tproblems• Create and send Invoices to our client's participants for any private amount owed each month• Compiles CMS compliance reporting• Reviews monthly COB files

Was the Lead in the Enrollment Department with 2 other Enrollment Specialists.• Train New Enrollment Specialists• Assist Enrollment Specialists on Issues • Provide Training for Clients• Assist in New Client Implementation • Enter and submit new enrollments in PACE programs to Medicare on a monthly basis for our clients • Review for any Enrollment problems that arise with our client's participants • Retrieve and post payments every month from PACE Participants • Reconcile A/R and Review the Aged A/R for each client, address any Discrepancies • Download Monthly Reports issued by CMS and distribute to clients • Download and Review Daily Report issued by CMS for any changes or updates to the client's participants• Provide documentation for our clients to Attest they are receiving the correct payment from Medicare each month • Complete and Submit a Monthly Audit of Enrollments submitted for each client to CMS • Work with CMS' Regional Office Account Managers and Third Party Contractor to resolve any Enrollment problems • Create and send Invoices to our client's participants for any private amount owed each month

Currently the Lead in the Enrollment Department with 2 other Enrollment Specialists. • Train New Enrollment Specialists• Provide Training for Clients• Assist in New Client ImplementationEnter and submit new enrollments in PACE programs to Medicare on a monthly basis for our clients• Review for any Enrollment problems that arise with our client's participants• Retrieve and post payments every month from Medicare, Medicaid, and Private• Reconcile A/R and Review the Aged A/R for each client, address any Discrepancies• Download Monthly Reports issued by CMS and distribute to clients• Download and Review Daily Report issued by CMS for any changes or updates to the client's participants• Provide documentation for our clients to Attest they are receiving the correct payment from Medicare each month• Complete and Submit a Monthly Audit of Enrollments submitted for each client to CMS• Work with CMS' Regional Office Account Managers and Third Party Contractor to resolve any Enrollment problems• Create and send Invoices to our client's participants for any private amount owed each month

Create and perform testing of our Billing Software for Progressa upgrades • Advanced Knowledge of Medicare Requirements for Homecare Billing and Submission • Advanced Knowledge of Patient Records and Medicare Requirements needed for successful submissions and payments • Manage the tracking process of Patient Assessments for Coding and Medical Review Including delegating notes to Medical Review Nurses and Medical Coders • Track and correct errors on Medicare Assessments for resubmissions • Troubleshoot and Identify Billing Process Errors • Train Medical Staff on Proper Medicare Submission Guidelines • Run weekly reports

Responsible for claim submissions and edits for Commercial Insurances and Medicare • Responsible for Data Entry Regarding Supplies Patient's Used During Home Care Visits

Scheduled Patient Appointments Using NextGen • Checked in Patients o Verified and Managed Patient Insurance Updates and Changes o Managed and Updated Patient Demographic Changes • Managed and Received Incoming Patient Phone Calls • Responsible for Faxing Patient Reports • Pulled Patient Films for Upcoming Visits and Requests • Addressed Patient Complaints and Concerns • Responsible for Coding Patient Encounters o Including advanced knowledge of ICD-9 and CPT Codes