Crystal Dailey Email & Phone Number

Perform triage of tips in the Triage Inventory that has been assigned from the Authentication TeamReject TIPS that are incomplete or do not follow SOP.Document in a professional manner the investigation activities that were performed on TIPS.Initial review to look for quick closing opportunities or already actioned providers.Maintain ORS Mailbox. Review and communicate back to all correspondence received.Claim Processing, Researching Provider Demographic Information, and/or Insurance Billing PracticesCommunicate with internal/external partners as needed.

Analyzing and Problem SolvingResearch and understand how a claim was paid.Obtain relevant medical records to submit appeals and grievance for review.Identify and obtain additional information needed to make an appropriate determination.Ensure members obtain a full and fair review of their appeal or grievance.Document final determination of appeals or grievances using appropriate templates, communication processes.Facilitatetor of the Wisconsin Hearing PanelSupport claim processing functions including investigation, negotiating settlements, payments, adjustments and research regarding eligibility.Insuring the proper processing of medical and dental claimsUpdating authorizations in ICUEMaintaining contact with member’s and providers regarding decision made by the Health PlanDocument final determination of appeals or grievances using appropriate templates and communication processes.Understand and adhere to applicable federal/state laws and regulations.

Handles all inquiries from members, providers and group contacts about available benefits.Promotes and maintains a positive company image through direct contact with customers.Exclussions and limitations to benefits.Case ManagementStatus of claim submitted and how claims were paid.HIPAA GuidelineInsurance Verification/AuthorizationsRX questionsClaims AdjustmentCoordination of Benefits issues/verificationMembership and billing issues, including. 1. Id Cards 1. Member information 1. Online access to benefits

Handling Inbound/Outbound calls pertaining to reconciliation and collection of delinquent accounts, either directly or through appropriate channels including payment inquiryReview customer inquiries, billing adjustments and bundle options.Upselling to potential customers and existing customersIdentifying write off accounts.Utilize automatic dialing systems.Making payment arrangements and writing payment plans.Process non pay reconnects, upgrades/downgrades and or disconnect work orders.Build team morale and team meetings.

Data Entry/EDIEnter orders for wholesalers and retails chains.Shipping/shipping inquiryProcessing Pos