• Manage daily operations and activities of 34 overseas staff consisting of 7 departments for all United States A&C legacy business units. • Created a cross training program, ensuring that staff members are able to perform confidently and effectively in all positions.• Weekly auditing, generating monthly reports, creating documentation and KPI metrics for evaluation of staff progress.• Applied effective strategies and led the implementation of improved nonbillable service codes across all venues reducing nonbillable service losses by $3,000,000. • Reduced overseas labor cost by 25%.

Service Coordinator- Supervisor of CF and Authorizations• Manage team overseas and stateside, training, created training documents and videos and creating KPI’s for evaluating staff progress. • Review and analyze contract requirements to ensure completeness and note any compliance requirements• Track and organize data for billing team, obtaining resolution on deferrals and obtaining any required documents or correspondence needed to ensure full reimbursement or services. • Audit all converted appointments for clean payroll, audit all billable and non billable appointments maximizing contract fulfillment, along with ensuring contract compliance. • Auditing, Trouble shooting and Identifying payroll errors • Responsible Contract Fulfillment-Service Coordinators, ensuring that authorizations for ABA and Mental Health medical contracts are maximized and authorizations are entered into Central Reach accurately.

• Creating, Auditing and maintaining all new and existing benefit plans, to optimize accuracy of authorizations and claims processing as well as minimize Member complaints. • Interpreting and translating of Health Plan benefits to corresponding procedure codes (HCPC and CPT), including diagnosis codes when needed (ICD-10).• Building Benefits Handbook, to ensure future accuracy of benefit plan building.• Identifying and coding benefits requiring limitations and exclusions, building advanced rules when needed. • Liaison between benefits department and all other departments, verifying member coverage for specific benefits and verifying copays for approved benefits. • Contact health plans for benefit interpretations and clarifications for use of benefits for Member Service Benefit Administration.

• Verifying and updating Member eligibility, demographics, Coordination of Benefits (COB) and Medicare Secondary Payor (MSP). • Liaison between Members, Health Plans representatives and Providers.• Maintained and created spreadsheets identifying eligibility issues, and resolutions; identifying affected claims and authorizations.• Assisted with the Monthly Health Plan Inload files, verifying errors and ensuring the monthly eligibility from the Health Plans were added to the system EZ-cap.

• Managing inventory, ensuring that work loads are organized and distributed timely to staff. Tracking six other department members daily, ensuring goals are met. • Escalating issues with staff and inventory to Manager and Director, assisting in the developing process.• Liaison between claims department and all other departments. • Training new staff and current staff in all processes and procedures, adhering to company guidelines. • Identifying trends and process improvement opportunities. • Responsible for processing contracted and non-contracted professional senior and commercial claims within the guidelines of CMS and DMHC AB1455. • Managing and processing Appeals and Provider Disputes in accordance to AB1455 and CMS regulations.• Responsible for managing and processing all in-house pharmacy mail out claims. • Process 150 claims a day with an average of 97% accuracy• Proficient in processing Home Infusion, Home Health, Dermatology, Cardiology, DME, Family Practice, Internal Medicine, Ambulance, Anesthesiology, Lab, Pathology, Radiology, Physical Therapy and Urology.

• Responsible for overseeing and managing the reimbursement department business activities and operations when manager was not present.• Supervised and assisted ten other department members and various other departments in the organization, fixing any day to day issues when necessary.• Filtered all collections and billing questions, resolving issues and directing questions to Reimbursement Manager when necessary. • Provided daily operational leadership , serving as a consultant to intake, pharmacy and delivery department. • Autonomously identifying and resolving issues related to billing and collection accounts.• Training new employees, skill assessments, instructing proper billing procedures and addressing complaints and resolving issues per Walgreens policies and procedures.• Supervised draft appeals, letters to providers, and agencies in the pursuit of payment confirmation of contractual compliance and respective billing policies, as in accordance to the contracts. • Reviewed new billers claims for the first 30 days and all claims with a value greater than $5000.00, documenting the review and returning claim to biller if necessary. • Prepare and process A/R audit adjustments for review and approval of Reimbursement manager • Prepared monthly reports for month end closing• Verified completeness of delivery tickets, verified coverage and patient eligibility was accurate in system prior to billing claims through electronic systems or by mail on HCFA 1500.• Reviewed monthly reports to verify accuracy of claims billed under correct therapies, locating outliers and reporting findings to pharmacy manager and general manager. • Prepared bad debt write offs• Reviewed and distributed incoming mail in the absence of the Reimbursement Manager.• Utilized as the department expert for Microsoft Word and Excel, correcting spreadsheets and forms. • Cash posted• Additional duties include Reimbursement Specialist II duties below.

• Responsible for billing, timely filing, collections and appealing home infusion medical claims to health insurance companies and their affiliates.• Accountable for analyzing and developing strategies to promote timely reimbursement of claims with an approximate monthly average A/R of three (3) million dollars. • Billed out over 700 claims monthly on 1500 HCFA forms, both electronically and paper. • Liaison between all departments; amending prescriptions and verifying shipments and deliveries, assisting with obtaining authorizations and insurance verification for billing purposes.• Sent patient statements, arranged payment plans, loaded patients into collections agencies when necessary.• Able to do insurance eligibility checks and check status of authorizations, both via phone and through insurance portals. • Capable of obtaining medical documentation from hospitals, medical offices, etc. in order to meet requirements for payers to make payments in full.• Negotiating Letter of Agreements for home infusion with non-contracted insurance companies, hospitals, and other medical related organizations.