Danielle Nesbit Email & Phone Number

Greater Chicago Area

Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment errorProviding assistance to providers and support staff regarding claims issues, eligibility and benefits.Utilize Trizetto software to look up and process workload on a daily basis while maintaining productivity standards. Analyze incoming claims ensuring proper ICD -10 CM codes, pay rates, claim forms are used and timely filing deadlines are maintained.Endorse that claims are being billed according to the MCO guidelines as well as the HFS and CMS. Communicated with providers to educate them on important changes to regulations, procedures and access to contract information. Trained other new Associates on proper procedures for Provider Services. Made use of multiple licensing internet sites to obtain required verification on new Provider enrollments and re-enrollments.Submitted and researched information regarding claims to complete resolutions to provider inquires and/or disputes.

Greater Chicago Area

Responsible for assessing, analyzing and rendering appropriate claim decisions pursuant to certificatesCommunicating with a variety of constituents to gather information relevant to claim based upon provisions of the policyClarify functional capacity through independent problem solving measures and discretionUtilize tools independently and accurately to identify work to be completed across the entire claim block, prioritize work, determine if/when to involve specialty resourcesAdhere to federal and state law to maintain appropriate and timely claim outcomes.