Emily Hutton Email & Phone Number

Remote

• Document detailed claim information in database • Verify member’s information is correct • Review trip logs making sure prior authorization is correct • Review if claim is eligible for payment based upon obtained data • Drive high client satisfaction through accurate and timely claims processing • Approve or deny trip signatures • Comply with established departmental metrics • Report possible Fraud, Waste, and Abuse to department leadership • Follow up with clients and members with detailed information answering their inquiries in a timely manner on behalf of the Claims Department via e-mail• Research claim information for the Quality Management Department regarding complaints • Provider continuous support to the ambulance adjudication team• Review CMS 1500 forms for any errors or missing information • Review prior authorizations• Review any crossover trips for errors or missing information • Price trips accordingly per Medicaid rate or contracted rate • Add special fees according to HCPCS code on form • Verify CPT and HCPCS codes are correct • Upload all processed claims to Online Access• Perform audit requests

Remote

• Handle inbound calls from Members, Clients, and Facilities to verify eligibility and coordinate non-emergent transportation utilizing MTM systems (AS400) in order to meet contact service levels • Maintain very high stats by following various protocols for different health plans• Provide top-quality customer service experience to a diverse customer population• Schedule trips in the most cost-effective manner• Meet job specific key performance indicators and goals• Help co-workers raise their QM by doing side-by-sides, listening, and help evaluate their calls and give appropriate feedback• Respond to all inquiries within a timely and professional manner• Recognize, handle, and refer situations of an emergent nature• Respond and document customer complaints

Chesterfield, Missouri, United States

• Complete tasks in a timely manner• Analyze and research various accounts via correspondence, queues, and reports• Take the correct approach to maintain and/or change account information based on MOHELA guidelines and procedures and Federal and State regulations• Help train new hires on the Enrollment and Deferment process• Track and report completed tasks

St. Charles County, Missouri, United States

• Enter various forms of data into an Excel spreadsheet• Communicate with various clients (Citibank, Discover Card, Chase Bank N.A, Capital One, CFNA, USAA, Synchrony (G.E.), American Water, Bank of America, etc.) • Proficient in FDCPA, UDAAP, SCRA, ADA, and all state laws and regulations• Download client requested calls • Listen and evaluate a wide range of calls • Help with remote training new hires in the Costa Rica office• Member of the Compliance Committee that met once a month to discuss the proper steps to take in regard to collectors not following client and company specific guidelines