Work closer with the Health Plan and contracting contacts to ensure providers are set up correctly in the system as they are enrolled/contracted to make sure they are paid as they expect per their contract and that we are following CMS guidelines. Research correct configuration for Medicare processing of claims. Keep the Payment Index up to date and accurate. Review/respond to cases submitted by PDM to set up providers. Test CRs created to correct or configuration pay classes, interest, rates… Show more Work closer with the Health Plan and contracting contacts to ensure providers are set up correctly in the system as they are enrolled/contracted to make sure they are paid as they expect per their contract and that we are following CMS guidelines. Research correct configuration for Medicare processing of claims. Keep the Payment Index up to date and accurate. Review/respond to cases submitted by PDM to set up providers. Test CRs created to correct or configuration pay classes, interest, rates, etc for providers. Review and clean up affiliations created for providers. Prepare projects to be sent to the project team to correct claims that were priced incorrectly. Create documents (SWI) and steps to help other BAs to learn and conduct their daily tasks to the best of their ability. Collaborate with many teams across the organization to research questions/issues and get providers/networks set up appropriately. Part of the special teams that tested PIX automation, check run review, CMS audits and many other special projects to help improve the quality of the team . Preformed training for fellow collogues to strength their skills. Performed demonstrations for Management and other leaders to show what our tasks/job intel and help make the processes better. Work closely with the HP to answer their questions and concerns and give them information needed to explain things to the providers. Show less

For 1 year Claims Liaison- Go between contact for the Claims processing team and the Health Plan. Researched claim issues/concerns of the both teams and found resolution. Reviewed check run to ensure providers pay days were correct. Created claims projects for providers when they were not paid correctly and when research showed we needed new configuration for the provider to be paid accurately. Created and wrote SWIs (job description documents) to help the team know the tasks expected of them… Show more For 1 year Claims Liaison- Go between contact for the Claims processing team and the Health Plan. Researched claim issues/concerns of the both teams and found resolution. Reviewed check run to ensure providers pay days were correct. Created claims projects for providers when they were not paid correctly and when research showed we needed new configuration for the provider to be paid accurately. Created and wrote SWIs (job description documents) to help the team know the tasks expected of them and step by step how to perform them. Conducted training sessions for new Liaisons coming in to prepare them for the floor. Worked with Business Analysts, Configuration team, benefits team and many others to ensure the providers were set up correctly and on the correct pay class to get the payments they expected and their contracted stated. Worked and created Omni tickets to get claims reprocessed correctly. Show less

Train new employees on the expectations and processes of a claims analyst. Manage reports and inventory for the network/state working to ensure we were on target and aligned with the companies expectations. Collaborate with other teams such as high dollar, Payment Integrity, Claims Liaisons and other networks to ensure providers were being paid correctly. Monitor inventory numbers to make sure the companies goals were met. Work projects and adjustments to correct claims that were incorrectly… Show more Train new employees on the expectations and processes of a claims analyst. Manage reports and inventory for the network/state working to ensure we were on target and aligned with the companies expectations. Collaborate with other teams such as high dollar, Payment Integrity, Claims Liaisons and other networks to ensure providers were being paid correctly. Monitor inventory numbers to make sure the companies goals were met. Work projects and adjustments to correct claims that were incorrectly paid. Create new processes and techniques to help with completing the inventory timely and accurately. Mentor teammates in their current position and help build the steps they need to get to their next position. Process claims, adjustments and projects. Answer emails and Omni tickets on processes and correctly claims for providers. Show less

Process First Time claims, adjustments and projects to get the provider a pay day. Review and research omni cases and claims to ensure providers were paid correctly. Manage time to ensure expectations were met for production. Review and process high dollar claims as part of a special team. Collaborate with other teams to ensure providers were being paid correctly. Process check run claims and stop claims from going out incorrectly.

Opened a new and used sports equipment shop that also specialized in screen printing uniforms and apparel for teams, schools and organizations. Researched and set up the business processes and procedures. Ran the day to day operations of stocking, pricing, reporting, customer service and screen printing. Created the documents needed to run the business.