Ann Zirschky Email and Phone Number

I advise and assist with Medical Billing and Compliance issues as well as other things that come up to make the dream work for our Client!

Government Programs Senior Advocate ClaimsBlue Cross Blue Shield - Kansas City, MOSeptember 2021 to February 2022• Assist and train Customer service reps on claims.• Identify internal and external department issues with claims processing.• Understand CMS compliance and billing• Assist with explaining to moderate to complex billing concepts to providers.• Assisted with designing a escalation program to get claims issues from front line phone reps to otherdepartments.• Assisted with training reps for the escalation program.• design and maintain training documents.• BCBS of Kansas City KC-Remote Process Medical claims for BCBS of KC in varying degrees ofcomplexity.• Be able to process claims/written correspondence with varying level of trainings.• Efficiently monitor several Applications at one time. utilize Facets, Blue Help, Bi portal, Perceptive aswell as Excel and Teams.• Processing commercial claims, doing both first pass and adjustments.• Assists other lines of Business as needed with limited notice• Provided Assistance Within Government programs in a customer service, and claims knowledge role.• Make sure Medical Records are secured per HIPAA guidelines.• Review PA/UMs and verify if they are applicable to Current claim.Accomplishments• Whilst working assisting Government programs, I have identified several reasons why claims werenot paying.• Utilizing LCDS from Medicare and other resources,• As well as identified markers on LHO claims that were converted.• Troubleshot and corrected issues with claims denying outside of the terms in which they should.

• Ensure compliance within my role and the ones before me• Work without Direct supervision• Maintain a high level of productivity and orders moved as well as quality.• Review Orders/Chart notes to establish medical Necessity based of insurance requirements.• Evaluate paperwork needs for each order, and request documentation from appropriate doctor basedon insurance guidelines.• Review and keep up with Medicare Regulations pertaining to durable medical equipment.• Scan. Time date Hand carried documents from providers into Laserfiche. And file for audit purposes.• Explain Compliance regulations as needed to customer service reps, and ATPs.• Sit in on monthly meetings pertaining to Medicare and other insurance requirements, and update otherrepresentatives within my branch.• Work all of KCMO, and surrounding areas orders. And assist with other regions as needed.• Utilize Medical Terminology, while interacting with both customers and providers.• Contact Providers every 3 days to resolve needed paperwork and answered any questions they needed,while staying compliant per insurance guidelines and regulations.Accomplishments• In my role I earned two Awards for orders moved, and Quality.• Helped improve Several Process’s involving Organization and Compliance.• Designed a Standard operating procedure for 7 Element order forms.