Arvay Goode Email & Phone Number

Tampa, Fl, Us

United States

* Maintain calendar of appointments and meetings* Schedule appointments* Provide back-up if needed with answering incoming calls* Maintain the office layout with efficiency and organization in mind* Collaborate with ADP to create, update, and maintain office procedures* Maintain office equipment in good working order * Pay and record invoices* Accurately maintain general office budget * Submit referral requests to PCP office for patients with HMO plans.* Maintain incoming faxes thru fax log.* Communication: Communicate with staff, clients, and other professionals* Supervision: Oversee and monitor staff, such as administrative workers and secretaries* Administrative tasks: Create, develop, implement, and maintain structure for employees to improve productivity and safety* Works with E-clinical for scheduling, checking insurance, sending referral request, and communication with providers

Position Purpose: Perform various analysis and interpretation to link business needsand objectives for assigned function• Support business initiatives through data analysis, identification of implementationbarriers and user acceptance testing of new systems• Identify and analyze user requirements, procedures, and problems to improve existingprocesses• Perform detailed analysis on assigned projects, recommend potential businesssolutions and assist with implementationEducation/Experience:Bachelor’s degree in related field or equivalent experience. 0-2 years of businessprocess analysis or data analysis experience. Advanced knowledge of MicrosoftApplications, including Excel and Access preferred. Project management experiencepreferred. Xcelyis experience preferred.Our Comprehensive Benefits Package: Flexible work solutions including remoteoptions, hybrid work schedules and dress flexibility, Competitive pay, Paid time offincluding holidays, Health insurance coverage for you and your dependents, 401(k) andstock purchase plans, Tuition reimbursement and best-in-class training anddevelopment.

Perform facility (hospitals and clinics) enrollment in the provider data management system▪ Enroll providers and practitioners in the provider data management system▪ Update facilities, providers, and practitioners with claims payment information▪ Research, review and make updates within the provider data management system per provider requests▪ Perform quality service checks on systemic data▪ Perform research and resolve problems

Provided assistance to both internal and external consumers via inbound and outbound inquiry in • Reviews and responds to written provider disputes, clearly and articulately outlining the payment discrepancy to the provider.▪ Thoroughly researches post payment claims and takes appropriate action to resolve identified issues within turnaround time requirements and quality standards.▪ Navigated CMS and State specific websites, as well as AMA guidelines, and compare to current payment policy configuration in order to resolve the providers payment discrepancy.▪ Reviewed medical records to ensure coding is consistent with the services billed and compares against the clinical coding guidelines in order to decide if a claim adjustment is necessary.▪ Processed claim adjustment requests in Xcelys following all established adjustment and claim processing guidelines.▪ Utilize SharePoint and Excel as necessary to work through daily inventory assignments.▪ Identified and escalated root cause issues to supervisor for escalated review.▪ Reviewed and responded to internal escalated provider disputes transferred by management and other associates.▪ Acts as liaison with other departments when additional clarification is needed about claims payment policy disputes.▪ Assisted team members with training opportunities and coaching.▪ Assisted with special projects as assigned or directed.

Claims Specialist II▪ Processed claims that pend for various hold reasons to assist in the final determination on claim disposition▪ Identified root-cause issues to ensure enterprise solutions▪ Assisted with special projects as assigned or directed.▪ Researched and processes institutional and professional claims▪ Researched complex claims issues and works with all external departments, markets, and providers on claims related content▪ Worked FMTS, CORTR and MNFEE report

Process background and drug investigations to include review with StaffingConsultant and/or HR Manager• Conduct telephonic reference reviews• Daily use of HR recruiting system (VurV and Taleo)• Attend and assist with job fairs• Establish and maintain employee personnel files• Update Human Resources Access data-base system to include new hireinformation, training summaries, birthdates, emergency contacts, manager’s reportingsystem, promotions, demotions, short-term disability and personal informationchanges• Assist with HR administration by collecting documents from internal and externalsources• Administer clerical and written testing to potential candidates• Reception and telephone to include greeting candidates• Copying, filing and sorting documents• Route incoming and outgoing mail• Maintain Human Resources general filing system• Prepare new hire orientation booksPhone screeningsCreated interview packets for hiring managers

Provide support to the Member Service Organization and Provider Contact Centerdepartments (correspondence, filing, faxing, copying and other general duties)• Route incoming and outgoing mail• Run reports for pending, effectiveness and overtime schedules• Tracking inventory• Review Eligibility of Benefits in BlueCross Blue Shield systems such as Diamondor Legacy• Order supplies for the departments• Placing outbound calls to provider offices notifying them about member’s servicesuch as approved, denied or pending• Input and retrieve data using a PC• Heavy keying• Read, answer and prepare correspondence