Leads and motivates team to ensure continued development and progression of system use and functionality Initiates and presents ideas and plans for developmentCoordinates each Rules Engine update deploymentOversees system audits to ensure appropriate use and provide additional training for client as neededContinuously researches of Workers Compensation state Medical Fee Schedules to create new rules for additional statesCreates new software business rules… Show more Leads and motivates team to ensure continued development and progression of system use and functionality Initiates and presents ideas and plans for developmentCoordinates each Rules Engine update deploymentOversees system audits to ensure appropriate use and provide additional training for client as neededContinuously researches of Workers Compensation state Medical Fee Schedules to create new rules for additional statesCreates new software business rules and performs initial testingPerforms limited SQL Server queries for reports  Coordinates with end user management to understand desired functionality in all possible situationsDetermines severity and priority of bug and enhancement requests Utilizes Bugzilla bug-tracking systemCommunicates with end user team on bug and enhancement requests Fixes and tests bugs and adds enhancements as appropriate Oversees testing of software to ensure accurate functionalityMaintains databases used by systemResearches database updatesPrepares databases to be loaded into systemWorks with DBA (database administrator) for loading of database updatesOversees testing of database load to ensure accurate data and load Show less

Involved in design of software UIInvolvement in initial deployment of systemTraining of softwarePerformed research of Workers Compensation Medical Fee Schedules as basis of system rules Created software rules in Rules Engine for desired functionalityCoordinated with software end user team to understand desired functionality Tracked and maintained issue and enhancement requestsTested software to ensure accurate… Show more Involved in design of software UIInvolvement in initial deployment of systemTraining of softwarePerformed research of Workers Compensation Medical Fee Schedules as basis of system rules Created software rules in Rules Engine for desired functionalityCoordinated with software end user team to understand desired functionality Tracked and maintained issue and enhancement requestsTested software to ensure accurate functionalityMaintained databases used in systemResearched and prepared databases to be loaded into systemWorked with DBA (database administrator) for loading of database updatesTested database load to ensure accurate data Show less

Reviewed Medical Bills according to state specific fee schedule regulations-Outpatient facility-Inpatient facility-ProfessionalVerified national correct coding guidelinesProcessed appeals and reconsideration requests via reprocessing bill or creating letters explaining reviewCommunicated with insurance companies over the phone and in writingInitiated research on appropriate fee schedule regulations to determine appropriate processing

Audited medical insurance accountsCommunicated with patients over the phone and in writing to ensure correct demographic and insurance informationCorrected diagnoses and procedure codes for resubmission and/or appealing claim formsCommunicated with insurance companies over the phone and in writing