Beth Thompson Email & Phone Number

Create and manage the delivery schedules for the various Claims initiatives. Coordinate meetings and hold team members accountable for delivery of project tasks.Develop plans and manage business resources in delivering of claims projects and adjudication system updates/changes.Develop and maintain implementation documentation and communicate status and concerns to Claims Manager. Provide status reporting to management and respond to inquiries about projects.Ensure claims reports are implemented to allow ease of use for staff.Provide training of new hires and ongoing training to staff. Ensure an effective training program is developed and executed. Create, update and assist in implementing Standard Operating Procedures. Ensure policies and procedures are updated as relating to claims. Assist in updating Provider Manual and other resources as required.Work with internal business partners to identify system deficiencies affecting claims processing and assist with creating business requirements to submit for system updates.Ensure resolution of claims issues across multiple operational areas.Provide recommendations for new or modified processes and procedures to reduce claims errors. Review and communicate audit results to management and business partners.Assess staff training and coaching needs, client service skills, product knowledge and system navigation skills.Recommend topics for huddles, changes to training and refresher training sessions as appropriate. Participate in calibration sessions to develop scoring consistency and best practices.

Assigned to over 800 Independent, Agency, and Group providers in our network and supervision of six employees.Assist other claims staff as needed with resolving customer service inquiries. Assist in training new employees and creating desk reference materials.Reconcile and assist in closure of provider issues. Speak with providers as necessary in order to ensure correct billing and understanding of billing issues. Log and track provider issues in order to remain under allowable metrics.Research denials, ensure providers are paid correctly and timely. Met monthly group/departmental goals by following preset metrics. Assisted staff in meeting individual goals through one on one meetings, coaching, and monitoring metrics. Held monthly staff meetings and additional meetings as necessary, led training updates and informed staff of pertinent changes and new information. Completed mid-year and yearly evaluations, also created individual performance improvement plans and monitored as required.

Claims adjudication, adjustments and reconciliation of Provider's billing. Proactively research claims denials, follow up with provider for claims corrections.Internal and external customer service by responding to telephone and email requests. Train new employees and new providers as needed. Billed the State of NC to ensure continued special funding for housing, disability accommodations, and other needs. Research unapplied receivables and correct ledger accounts through manual entry. Print and mail mass billings to members. Sent paper claim forms to appropriate payee and ensured correct billing to members.

Reconciled Accounts Receivable cash, received in-person payments, posted self-pay, insurance, Medicare, and Medicaid payments to patient accounts, and reconciled voucher denials with ledger system. Worked switchboard as relief, also filled in for Patient registration in the surgery center and Emergency Department. Filled in for Business Office Manager as needed, balancing all patient and insurance receipts, both weekly and monthly. Performed collection duties, phone calls and mail, worked in the insurance Department filing claims, paper and electronic, and performed denial follow-up. Assisted with accounting functions as needed, balancing ledger accounts and tracking Accounts Payable, updating weekly and monthly spreadsheets.