Daniel Sutton Email & Phone Number

Pittsburgh, Pa, Us

Pittsburgh, Pennsylvania, United States

- Resubmission of insurance claims after identifying initial submission was not received or has been rejected by payor.- Work multiple claim reports to ensure claims meet timely filing deadlines.- Makes corrections to insurance claims to ensure they process and pay correctly.- Monitors and manages assigned accounts to claim resolution.- Submits corrected claims to payer after making necessary edits on HCFA 1500 claim forms.- Write appeals to insurance companies to overturn denied or incorrectly paid clams.- Understand and resolve credit balances and write offs by submitting refunds or adjustments.

Lexington, Ky Remote

- Quality Prior Authorization & Correspondence Supervisor at Optum10/2019 - 10/2020Performed all regular supervisory functions: Responsible for all new hire on boarding, New hire paperwork submissions, Attendance reports, Time card reporting, Monthly and yearly reviews, Merit increases, Corrective action plans, Exit interviews and Terminations of employment.· Project managed multiple client projects through to completion, providing clients and management timely status reports to ensure all new client products launched successfully and that all target dates and deadlines were reached on time.· Managed all client meetings to review upcoming RX benefit changes and review any state and/or federal requirements. Review all target dates with client managers to discuss any potential risks or obstacles and communicate job status. Advise of any required signature’s that may be needed.· Reviewed all prior authorizations, approval, denial and letter templates to ensure they were exceeding client requirements, contract agreements, and all compliance regulations.· Implemented quality control process to monitor and improve departments quality of work, increase productivity and improve team deficiencies. (This reduced departments failure rate by 32%.)· Managed all aspects of quality for 21 team membersPerformed 84 quality audit evaluations monthly. Prepared and presented all quality reports to Vice President and Director. · Measured work against established metrics and expectations to ensure effective processes and increase production.· Create and manage all process improvement documents, job aids, work flows, SOPS, and training documents.· Developed and maintained professional relationships with both internal and external vendors and clients.

Lexington, Ky Remote

• Manage team schedules, meetings, department documents, and error reports• Manage daily inventory to ensure state and federal compliance regulations are met as per Medicaid and Medicare guidelines• Manage team schedules, meetings, department documents, and error reports• Assist providers with appeal process• Provide support to other team members with daily tasks, efficiency, caseload quota, and reaching their daily and monthly goals.• Complete quality audits on prior authorizations entered by agents to ensure quality, accuracy, and that all proper guidelines are followed.• Responsible for training all new staff on state guide lines, department Sops, authorization entry procedures, and department computer system training.• Serve as a United Healthcare Cultural Ambassador.

Pittsburgh, Pa Remote

• Entered prior authorizations for hospital admissions, surgeries, diagnostic testing, and durable medical equipment• Responded to incoming provider calls, faxes and email escalations• Provided status of existing prior authorizations and assisted providers in obtaining new prior authorizations• Provided detailed knowledge of Medicaid and Medicare guidelines for several different lines of business.

North Versailles, Pa

Mckeesport, Pa

Greater Pittsburgh Area

Monroeville, Pa

Bachelor Of Applied Science - Basc, Health/Health Care Administration/Management

Bachelor'S Degree, Health/Health Care Administration/Management