Alyssa Wolfe Email & Phone Number

Saint Paul, Mn, Us

Minnesota, United States

Greater Minneapolis-St. Paul Area

Greater Minneapolis-St. Paul Area

•Collaborate with business clients and technical teams to perform analysis, define business requirements, and implement innovative solutions that solve business problems or meet business objectives from a tactical perspective.•Maintain a comprehensive, sustainable project coordination process and work collaboratively with teams to support the business owner. Provide predetermined status updates to monitor progress, deliverables, milestones, timelines, resource allocation, problem solving strategies and outcomes that will result in successful implementation of projects.•Collaborate with IS and Claims to define project direction; develop project plans with technical and project management staff. •Coordinate key project activities. Drive project effort and facilitates project related meetings. Partner with upstream and downstream implementation to ensure seamless and predictable outcomes.•Collaborate with Claims Management, identify and implement repeatable and sustainable process improvement efforts involving enhancements to core claims processing systems, electronic data interface (EDI), vendor support functions; i.e. OptumHealth, RelayHealth, TC3, to increase administrative effectiveness and efficiencies.•Gather and translate business requirements and apply tactical business direction into technical requirements used for driving technical improvements, enhancements, or creation of new applications.•Communicate project direction and scope, and negotiate with teams to work through constraints and alternatives.•Negotiate and manage project scope, progress, and claims expectations. Communicate project updates as needed to management and claims / technical teams.•Assist technical team post-implementation for production support and ensure solutions continue to meet business requirements.•Develop and deliver ongoing training to business units to empower ownership of solutions.•Additional duties as assigned

Greater Minneapolis-St. Paul Area

-Work closely with Project Management on complex projects from end to end.-Create manual processes for patient account transfers that were unable to occur at a systemic level.- Analyze member accumulators (patient accounts) for UCare Choices plan to asses issues and help IS department address and correct system issues.-Create and update internal documents used by staff for processing and adjusting claims.-Update processes to stay compliant with state and federal guidelines.-Assisted in implementing new products/ system updates and changes.-Participated in program implementation for the Health Care Exchange.-Train new employees and also train existing employees on new procedures and processes. -Identify potential improvements in automated or manual processes to enhance claims processing, including improvements to policies and procedures.-Problem solve complex claim situations/high dollar issues.-Understand and accurately interpret UCare member and provider contracts, policies and procedures, as well as DHS, CMS and WPS rules and regulations.-Assist management in evaluating new employees.-Communicate inter departmentally to solve processing issues.-Participate in Employee Advisory Group meetings.-Test UAT scenarios for a Cost Saving Reduction process.-Worked closely with Coding and updated/cross walked internal documents for ICD -10.

Greater Minneapolis-St. Paul Area

-Assisted claim examiners with questions via email or setting up one on one training time-Handled high dollar claims-Solved complex claim issues from examiners-Handled special assignments from Management-Processed large numbers of Special Investigation claims-Managed Fairview Transplant Packages-Assisted with training of new employees-Assisted customer service with Choices questions-Participated in the Exchange implementation of UCare Choices- testing, recording and processed all the live claims for the first 6 months-Member of the Exchange Rapid Response team (oversight group)-Claims representative for Ucare Employee Advisory Group (EAG)- Processed claims for COB, Provider Issues, Authorizations, Adjustments, Ambulatory Surgery, Batch claims, Drug Pricing (RedBook), Family Planning, FQHC, Restricted Member, Mental Health, Member on Review, PCA, Hearing Aids, Multiple Modifiers, Manual Pricing, Waivered Services, DME State, Chemical Dependency, Hospital Outpatient, Hospital Inpatient, APC.

Greater Minneapolis-St. Paul Area

-Heavy use of Maces EXP, CORS, Amisys/Job Input, Microsoft Excel, Microsoft Word, Microsoft Outlook, and Internet Explorer daily.-Adjusted single line recoups and whole claim recoups.-Adjusted medical and hospital claims.-Imputed data into important client information systems.-Updated client customer reports.-Reinstate claims/Single line reinstatements. -Updated member counters and adjusted each claim accordingly.-Copied and Re adjudicated claims.-Reprocessed claims for recoveries.-Pull claims from EXP, assess COB/EOB and determine which claims to recoup/reinstate.

St. Louis Park Mn

-Scheduled patient appointments and intakes for new patients while accommodating doctor's tentative schedule. -Daily verification of patient insurances and collected payments at time of service .-Phone in new prescriptions, complete prior insurance authorizations~ and appeal medication prior authorization denials.-Implemented Visa/MasterCard machinery.-Dictated doctor's professional and personal letters and relay all messages and prescription refills to the doctor. -Assisted in completing Independent Medical Examination reports. -Prepare medical records, pull and prepare charts, and assist patients with individual concerns. -Responsible for collecting, posting, and managing account payments and entering charges and payments into Medisoft.-Prepared and submitted clean claims to various insurance companies electronically or by paper. -Obtained remittances from insurance companies and entered data into computer system daily. -Followed up on submitted claims, identified and resolved patient billing complaints. -Prepared reviews and sent patient statements. -Evaluated patients' financial status and established budget payment plans. Followed and reported statuses of delinquent accounts.-Performed daily backups of office computer systems. -Performed various collection actions; contacted patients by phone and corrected and resubmitted claims to third party payers. -Completed prior authorizations per insurance requests for denied payment for dates of service. -Completed application processes for doctor's participation with new insurance companies and also prepared re credentialing documents.

Medical Administrative/Healthcare/Coding, Health Care/Coding

High School, High School/Secondary Diplomas And Certificates, 9-12