Eric Way Email & Phone Number

Louisville, Ky, Us

Louisville, Kentucky, United States

Louisville, Kentucky Area

Louisville, Kentucky Area

o Redesign and expansion of Clinical Audit team including hiring and realignment of associateso Development and implementation of new Clinical Audit concept teamo Clinical Audit inventory managemento Collaboration, planning, and implementation of various clinical auditso Reporting of program financials and other metrics through the use of various Microsoft Office productso Providing training and education on various processes for nurses and non-clinical staffo Design of a new audit tool for nurses and collaboration with vendor for planning, build, testing, and implementationo Staffing nurses for current clinical audit inventory and also planning for future growth of clinical audit programs

o Development of new Clinical Audit processes through the use of Microsoft Visioo Streamlining of existing Clinical Audit processeso Implementation and planning of new and improved Clinical Audit Processeso Inter-departmental collaboration in regards to education of Clinical Audit processeso Collaboration with IT areas for system automated enhancement regarding member and provider correspondence

Louisville, Kentucky Area

o Planning and implementation of outsourcing program for offshore claims adjusterso Preparing Mentor documentation and claims processing guidelines for a Clinical Audit processo Facilitating initial and continued training of offshore claims adjusterso Quality auditing of team members and offshore claims adjusterso Recognizing overpayment trends and collaborating with other teams to recover overpayments

Louisville, Kentucky Area

o Adjudicating medical claims for Medicare Lines of Business per Mentor guidelineso Reviewing Medicare claims and recovering overpayments per CMS guidelineso Specialty claims, including high dollar facility claims, anesthesia claims, home health claims, and moreo Processed direct reimbursements to Low Income Net Subsidy members for Medicare Part D Claims