Bryan T. Email & Phone Number

Binghamton, NY, US

Review and interpret provider contracts. Analyze claims to determine cost saving measures that can be taken. Run root cause analysis on all aspects of claims, including fee schedules, configuration, and provider research. Act as a Subject Matter Expert on claims and reimbursement policies. Update official company reimbursement policies.

Fee schedule and contract template maintenance. Analyze claims, pre- and post-payment, to ensure contracts and reimbursement policies and procedures are priced accurately Review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors. Recommend system changes, training and process improvements to prevent.

Review claims to determine if payment is correct.Updated systems with fee schedule and claims information.

Fee schedule and contract template maintenance. Analyze claims, pre- and post-payment, to ensure contracts and reimbursement policies and procedures are priced accurately. Review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors. Recommend system changes, training and process improvements to prevent.

Support claims analysis, processing, and adjudication by maintaining company databases and systems. Assist with claims auditing and processing, conducting data research as needed.
Create and execute complex data queries, and prepare management and operational reports. Test and verify system functionality, reporting issues for resolution. Verify and.

New York City Metropolitan Area

Reviewed, investigated, audited, and processed Medicare and Medicaid claims. Adjudicated Medicare and Medicaid claims for medical, facility, pharmacy, dental, and vision services. Ensured compliance with all applicable laws, rules, guidelines, policies, and procedures. Interpreted and reported audit findings, and compared analyses with established.

Maintained a large volume of workers compensation claims. Set financial reserves. High volume of customer service calls. Make sure claims are paid in a timely and correct manner

Assisted with analyzing and interpreting the stock market across various industries.