Senior Manager, Payment Policy
As a steward of the customer's premium dollar, I focused on ensuring both hospital and physician submitted claims correctly reported the treatment provided to the patient. This validation allowed for appropriate reimbursement for each service.My role was to educate both senior leadership and the provider relations area with the basic information as how medical claims should be submitted. This included exploring and discussing new editing potentials as well as monitoring industry trends. I was able to identify opportunities to reimburse medical claims appropriately and save money for both the customer, and for the company.