Donna Steece Email & Phone Number

Perform random and problem-focused audits of claims by researching benefits, reimbursement contracts, claim edits, claim policies, and procedures. Provide immediate feedback on claims with errors to claims analysts and team leaders.Review claims, verifying the accuracy of data entry including patient information, procedure and diagnosis codes, billed amounts, and provider data.Review plan benefits and determine coverage based on contract and claims processing guidelines. Accurately resolve or reprocess claims to correct processing, setup and/or system errors.Evaluate claims reprocessing requests to determine compliance with claims reprocessing standards prior to adjusting claims.Accurately resolve or reprocess claims due to updated eligibility, benefits or provider status.Review chart notes, claim itemization and other documentation. Communicate denial if the rebill does not meet standards and/or requires additional documentation.Work assigned reports to monitor and/or correct claims for specific processing reasons. Assist in processing other specialty claims/projects as workload or auditing requires.Identify overpayments and prepare recovery requestsProvide service to internal and external customers via customer service tasks, audit email queue, and phone to reprocess claims, answer questions and resolve refund issues. Document issues that affect claims processing quality and advise leadership of claims processing or system configuration concerns and/or problems.Provide support to department staff and internal customers to answer questions regarding claims processing rules and processes and overpayment transactions.Assist with grievance and appeal research and resolution.Develop and maintain positive relationships with outside vendors that contract with PacificSource for claims-related services via phone, email, or business letter.Develop training materials and deliver training to other analysts.Follow HIPAA laws and regulations

Bend, Oregon, United States

Provides claims support by analyzing, researching, investigating, processing and adjusting claims using Facets, Content Manager and Benefit TrackerConsistently meets established productivity, schedule adherence and quality standardsMakes phone calls as neededMaintains daily production and adjustment logsWorks special assignments as neededCommunicates with other departments via customer service tasks in Facets. Send documentation to providers/members regarding overpayment adjustmentsPerforms adjustments using multiple workbaskets in Content ManagerConducts adjustments to member medical accumulatorsUpdates member accumulator from prior groupProvides feedback for current documentation of policies and procedures

Bend, Oregon, United States

Provided timely processing and adjudication of claimsPrepared documents and other paperwork relating to claimsMaintained working relationships with departments processing claimsAssisted other departments (COB, Support, Data entry) as neededConsistently met established productivity, schedule adherence and quality standards

Bend, Oregon, United States

Efficiently performing data entry tasks, ensuring consistently high standards of accuracy and delivering exceptional levels of customer service at all timesProviding professional counseling, including grief counseling, to a diverse range of clients in accordance with individual needs, during the intake processResponding to queries and efficiently managing client issues, including transferring clients to the most appropriate department Supporting developmentally challenged individuals throughout the intake/data collection process to determine their eligibility to receive assistance when applying for social security disability benefitsUtilizing excellent communication and interpersonal skills to establish productive working relationships with colleagues and supporting team members to develop effective problem solving skillsEnsuring that all clients are treated with empathy and respect, including listening carefully to client needs, managing difficult clients and maintaining client confidentialityEfficiently maintaining multiple software applications simultaneously to ensure accurate and timely transfer of informationMaintaining control of calls and interacting with clients in a professional manner while determining the relevance of information being providedUtilizing strong organizational capabilities to effectively prioritize workload and manage time, enabling fulfillment of multiple responsibilities simultaneouslyPromptly relaying client issues to supervisors or team members via online chat programs while continuing to engage the client and ensuring that the intake process moves forwardUtilizing an excellent working knowledge of Microsoft Office programs, multi-line phone operations and all aspects of internet usage to manage information and research cases as required