Beth M. Beaver Email & Phone Number

Eagan, Minnesota

Primary support for global contact management system regarding product information and availability, order entry, shipping, tracking, warranty and RMA information. Responsibilities include identifying, analyzing and isolating root causes to resolve issues and enhance productivity. Act as liaison between end users, partners, sales managers and internal departments to ensure customer expectations are exceeded.

Optum

-Performed queries on relevant systems (e.g., claims systems; data warehouse) in order to obtain relevant information-Validated claims data against information from claims processing systems to ensure that data is accurate-Analyzed claims data against applicable internal and external policies, laws, and regulations to determine potential issues (e.g., billing anomalies; overpayments; claims processing system issues)-Reviewed paid claims to identify potential claims paid in excess of correct reimbursement-Reviewed history of related claims to pull in and understand additional claims-related information-Interpreted and/or integrated data from multiple sources to identify error trends and root causes of claims overpayment (e.g., duplicate payment; coordination of benefits; contract set-up/interpretation; potential fraud, waste, or abuse)-Validated results of claims analysis resulting from investigation to ensure accuracy and quality -Determined financial implications of potential courses of actions-Identified process efficiency improvement opportunities in internal applications and tools -Provided input into potential changes or enhancements to external systems (e.g., claims processing systems)-Assessed impact of new process, system, or tool on internal and/or external stakeholders (e.g., business units; clients)-Demonstrated understanding of processes and systems across multiple healthcare business segments (e.g., Medicare and Retirement; Community and State (Medicaid); Commercial; Behavioral Health)-Demonstrated knowledge of healthcare coding practices (e.g., CPT’s; HCPCS; DRG; ICD10)-Demonstrated understanding of multiple claims platforms (e.g., UNET; COSMOS; Diamond; FACETS; Unison; NICE)-Demonstrated understanding of and/or utilized applicable internal/external software applications

Examined the unique needs and concerns of a business to develop relevant practices and procedures for preparing business reports. This included creating and maintaining efficient and secure systems for recording data, electronically transferring data and producing relevant documentation to share with the client. Prepared claims utililization reports, eligibility and adhoc reports for clients as requested.