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.

• 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.

• 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.

• 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

• 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.

• 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