• Responsible for verifying and documenting Ambulatory Facility insurance benefits via phone or on-line for all patients.• Utilize a working knowledge of HCPCS coding.• Ensure that insurance information and diagnoses are updated and accurate.• Confirm pre-certification, pre-authorization or referrals prior to the date of procedure(s).• Contact patients regarding fiduciary responsibility due at the time of service.• Provide explanation of benefits and coverages as needed.• Assist Billing Department through Provation review to ensure accurate patient billing.• Process patient and insurance company payments.• Support patient registration as required.

• Manage day to day business within the office and clinic.• Schedule/reschedule patient appointments.• Ensure that client information is accurate in EMR.• Create and update weekly schedules for 2-3 physical therapists.• Accurately update and maintain patient files.• Obtained physical therapy prescriptions, tests and signed plans of care from physician offices.• Served as point of contact for Worker’s Compensation and Personal Insurance authorizations.• Verify eligibility and benefits with various insurance companies.• Collaborate with the Billing department to ensure that proper billing.• Opening and closing the office and clinic daily.• Receive and process copayments.• Process Medical Records requests for patients and attorneys.• Order and maintain supplies.

• Responsible for scheduling /rescheduling appointments and in-office procedures for 5 doctors and 3 audiologists in 8 different locations.• Manage automated reminder calls lists.• Ensure that all patient demographic and insurance information is correct and updated.• Manage No Show report and bill accordingly.• Assist with up loading of faxes and ensure they are routed to the appropriate doctor or other office staff members.• Assist with Medical Records release.

• Analyze submission of sleep study request and supporting physician’s notes for determining authorization of polysomnography or a home sleep test for patients with Obstructive Sleep Apnea.• Daily communication with doctor’s office, sleep facilities and patients.• Responsible for complete and accurate daily and weekly reports.

• Analyze and process claims which were transmitted to Teamsters Local 559 HS&IP via Anthem Blue Cross/Blue Shield. • Process claims by utilizing CPT and IDC 9 coding books to verify the correct diagnosis and procedure codes are being utilized. • Communicate eligibility and benefit information to providers as well as answering questions and handling any individual’s member health services issues.

• Research and reconcile system rejected claims to facilitate swift and accurate claim payment. • Research and reconcile refunds or reversals of electronic transfers or paper checks. • Assigned to special projects, including enrolling members in FSA and HRA for Reimbursement Accounting and remediating Vendor Fee Reimbursement claim reports.

• Work closely with Sales, Brokers, Contract Development and Regulations and various other departments to ensure that medical, dental and Life/ADD benefits are in compliance with Federal and State Mandates.• Responsible for creating all Summary Plan Descriptions, Policies and related documents within HIPAA standards, as well as establish they are also within compliance with State and Federal Mandates.

• Managed accuracy of coverage information provided to assigned clients. • Developed close working relationship with Sales departments and vendors to provide accurate coverage information to customers. • Ensured coverage cards were delivered in an accurate and timely manner.

• Worked primarily with Third Party Vendor and CIGNA systems to certify the accuracy, and timeliness of post enrollment materials sent to the client as well as monitored inventory to ensure quantity and quality. • Established that the benefits were correct in multiple systems and the information was properly relayed to the vendor.