•Initiate, negotiate and finalize Stat Laboratory Agreements with hospital/laboratory for DaVita Dialysis facilities.•Initiate, negotiate, finalize, and interpret proposals, amendments and fully executed Laboratory Agreements between Insurers/Medicare/Medicaid to ensure proper reimbursement.*Monitor and complete provider credentialing applications timely and accurately ensuring no disruption to billing.•Analyze contracted insurers to ensure reimbursement is according to Laboratory… Show more •Initiate, negotiate and finalize Stat Laboratory Agreements with hospital/laboratory for DaVita Dialysis facilities.•Initiate, negotiate, finalize, and interpret proposals, amendments and fully executed Laboratory Agreements between Insurers/Medicare/Medicaid to ensure proper reimbursement.*Monitor and complete provider credentialing applications timely and accurately ensuring no disruption to billing.•Analyze contracted insurers to ensure reimbursement is according to Laboratory Agreement.•Capable of prioritizing work load to meet multiple deadlines. Show less

• Consult with Benefit staff and Sales teams to review and finalize benefit design, review group structure and claim issues.• Ensure complete processing of major and complex accounts.• Evaluate system capabilities for product, or account changes. Implement and identify required programming modifications.• Verify the accuracy and completeness of documents needed to initiate a new group or group change.• Monitor timely and accurate updates of the benefit files, efficient design of… Show more • Consult with Benefit staff and Sales teams to review and finalize benefit design, review group structure and claim issues.• Ensure complete processing of major and complex accounts.• Evaluate system capabilities for product, or account changes. Implement and identify required programming modifications.• Verify the accuracy and completeness of documents needed to initiate a new group or group change.• Monitor timely and accurate updates of the benefit files, efficient design of benefits on multiple processing systems, and respond to internal and external benefit design inquiries. • Administer corporate projects, special tasks and special projects as assigned including conversion of processing system. • Manage benefit global files. Show less

• Maintained thorough knowledge of various automated claims processing systems, lines of business, procedures, benefits, contracts, enrollment, specific group, provisions, applicable insurance regulations and related corporate policies to ensure accuracy of services provided.• Analyzed, researched and completed on-line and manual adjustments of paid or rejected claims.• Processed inpatient and outpatient claims from all specialties from receipt to completion; answered telephone… Show more • Maintained thorough knowledge of various automated claims processing systems, lines of business, procedures, benefits, contracts, enrollment, specific group, provisions, applicable insurance regulations and related corporate policies to ensure accuracy of services provided.• Analyzed, researched and completed on-line and manual adjustments of paid or rejected claims.• Processed inpatient and outpatient claims from all specialties from receipt to completion; answered telephone inquiries, reviewed and/or initiated correspondence and adjustments.• Communicated with each customer until the inquiry was resolved to the customer’s satisfaction.• Facilitated special projects: on-the-job training of unit members and tasks, to enhance the overall efficiency, effectiveness and productivity of the department Show less