Answer inbound calls from patients regarding Dupixent.Assist patients in obtaining Sharps containers.

Review appeal and reconsideration requests, and route to the correct teams for review and processing.Reject appeal cases, missing pertinent information, back to the Provider for resubmission.Meet or exceed daily production metrics.

Daily data entry of Foreign Claims for member's traveling outside of the country.Reviewed claims to resolve issues impeding the auto-adjudication process.Provided expertise in appeals, reconsiderations, and addressing claims inquiries from Providers.

Answering email correspondence from the general public regarding COVID, travel restrictions, at home tests, and PPE concerns.

 Opthalmology billing (Barnet Dulaney Perkins Eye Center & Southwestern Eye Center) Currently assigned to work Commercial, Government anf AHCCCS Payers Review medical records for prior authorization/referrals Submit Reconsiderations/Appeals as needed Follow Payer’s timely filing guidelines Review Rejected claims in Navicure and make corrections to ensure a clean claim is generated Read EOB’s to determine if the claim has underpaid, recoupment or offset is needed Review EncoderPro for Global Period and ICD10 coding issues

Verify patient’s insurance eligibility using payer appropriate sites Commercial, Medicare, Medicare HMO’s, Medi-Cal Resubmit claims via mail with medical records for retro auth requests and appeals Review EOB’s for denials, capitation payments, patient responsibility Fax billing statements to attorneys Answer inbound calls from insurance companies and patients Outbound calls to insurance companies regarding denials. In charge of processing all Medi-Cal claims, submitting RTD's, calling on all denials, updating CPT's

• Verified eligibility for rendered services thru telephone contact with the insurance carriers.• Conducted thorough research to effectively resolve a Providers reconsideration or appeal.

Verify AZ State Medicaid benefits for patient'sSent facility claims electronicallyEnsure claims were billed timelyResearch claims that were denied, correct denials by submitting appropriate documents to insurance payerAppeal denials as needed to obtain paymentIf payer short paid, determine the reason for the short pay and appeal or request claim be reprocessedCurrently work Front Office at a Banner Clinic, scheduling follow up appointments, collecting co-pays, deductibles, answering phones

Medical Billing & CoderSent ambulance claims electronically on behalf of Rural Metro. Verified AZ State AHCCCS & Behavioral benefitsMedicare, Medicare HMO, Commercial, Supplemental and VA BenefitsUtilized AS400, Passport, Outlook, AHCCCS Portal for eligibility