Deidre Galloway Email and Phone Number

Clinical Appeals Assists Clinical Appeals Manager with training staff on daily procedures within the departmentFacilitated quarterly trainings on any payer updatesMet with management regularly to assess Accounts Receivable RisksAssists with staff communication, setting goals and resolving problemsMaintain departmental policies, procedures and objectivesAssists with payroll activities for staff (i.e., time sheets)Manage denial inventory of 11.1 million to decrease to 8.0 million Assists manager with developing and implementing action plansCoordinated resolutions with insurance payers to secure payment and overturn denialsAuthorize to approve all adjustments in the denial tool $5KPerformed weekly quality assurance analysis and provide direction on corrections

Review current and aged accounts $10K and greater to resolve denials Request medical records to review with nurse for appealsVerify with various insurance payers root cause of denialsPrepare formal appeal letters to insurance for reconsideration of paymentFollow-up with insurance on submitted appeals and requested information

Preverify medical insurance prior to appointmentRequest referrals from Primary Care PhysiciansEnter all data into system prior to scheduled appointmentPrepare all documents and super bills for each patientEnter all data for work compensation appointments and prepare Work linkWork aged accounts for managed care payers, Medicare and MedicaidPost Surgery Charges

Prepare medical claims on HCFA 1500 Worked all aged accounts to ensure proper paymentPrepared monthly statements for patient coinsuranceCollect payment from managed care payers, Medicare and Medicaid