Coordinate and maintain all provider setups and contracts for clients through PEGASYS systemHandle the implementation and conversion of new and existing client provider networks, including reimbursement setupTroubleshoot provider setups in support of the claim processing operation as necessaryHandle all provider, contract and provider reimbursement issues for clientsMaintain daily communication with internal departments regarding provider, contract, and reimbursement issues and resolutions Review capitation set-ups, adjudicate non-participating claims, compile statistical data and prepare reports as necessaryExtensive knowledge of managed care terminology; Medicare and Medicaid policies; reimbursement guidelines; and DRG, CPT, and ICD9/10 codingCompile and prepare statistical data and reports as neededMaintain relationships with clientsTrain new employees on PEGASYS system

Updated and maintained quality of provider records Implemented and converted new client provider data Maintained provider reimbursement structuresMaintained provider records in support of the claim processing operationAdjudicate non-participating claims

Researched relevant provider informationMaintained data entry and conducted quality checks of provider records as necessaryCommunicated directly with provider office staff and billing departments to supply up-to-date information.

Member of a four-person patrol team. Trained to perform arrests, operate emergency equipment, keep accurate notes and write effective reports. Also, trained in Crisis Prevention and four-point restraint. Perform other tasks requested by management.

Handled general administrative duties such as filing, faxing, copying, and mailing. Maintained records for fifty lawyers, including twenty partners and thirty associates.