I research all denials on medical claims and correct the issue or transfer to the correct department that will correct the issues. This includes authorization, coding, and eligibility denials. I have discovered and assisted in resolutions for credentialing and unlisted code issues that were being written off that ware now being paid. Due to the nature of my position, I am experienced in the following areas:• Familiar with how to zero balance claims.• Knowledge of guidelines for Centers for Medicare and Medicaid Services, Arizona Medicaid, and Colorado Medicaid.• How to determine Medical Unlikely Edits and how to use the tools on CMS and Noridian to determine the general coding errors so the certified coders can verify what corrections need to be used.• The ability to use the American Medical Association ICD 10 and CPT 2020 professional coding book to also research the errors as I am currently enrolled in an AAPC coding course to be certified.• HIPPA regulationsI use a variety of tools to accomplish my goals that include the following:• I am an intermediate user of Excel and familiar with the other office products• NextGen software• Cerner• Powerchart• MS 4• nThrive

Took calls from members to assist them with road side assistance.

• Conducted monthly analytics for processing errors and identified trends and helped introduce processes that reduced errors by 59%.• Audited processing procedures for Worker’s Compensation bills to ensure state and client guidelines were followed and that fee schedule and contract pricing was correct.• Requested adjustment of bills when a payment error was found upon audit listing specific error that needed correction.

• Consolidated data and criteria from various overpayment research teams into one specific form to track overpayments.• Collected and analyzed data in Excel and created buckets to group errors so tracking of error trends was possible and helped to initiate practices for error reduction based on the data collected.

• Audited processing procedures for Worker’s Compensation bills to ensure state and client guidelines were followed and the fee schedule and contract pricing was correct.• Sarbane Oxley audits – Verified client contract information was correctly input into the MCPS pricing program.

• Ran a project converting Worker’s Compensation bills from the Powertrack system to the Bill Review system. Resolved issues that prevented the conversion process.• Mentored team members in how to improve their quality and speed for processing bills and adjusted bills that were incorrectly processed.• Worked as a liaison between different teams and departments.

My duties were to process Worker's Comp bills for correct payment. This included a knowledge of state guidelines, invoice and implant processing and the ability to look up fee schedule guidelines and pricing.