Erin Pike Email & Phone Number

Palo Alto, California, United States

San Diego, California

• Identify claims to audit using our Fraud, Waste, and Abuse algorithms
• Review audit documentation from pharmacies, and potentially the prescriber, to verify that the pharmacy is in compliance with state and federal guidelines
• Train and mentor new hires on system processes

Louisville, Kentucky

• Cotiviti helps providers and insurance companies keep costs down by making sure insurance claims are being paid correctly and efficiently.
• Identify concepts that create revenue for Cotiviti and clients (for example, pinpoint DME modifiers that were billed incorrectly, resulting in $1.5+ million in recoveries)
• Use multiple platforms and client systems to research and audit claims
• Research CMS documents and provider contracts to create opportunity for potential overpayments (for example, a provider billing the incorrect NPI resulted in $750k+ in overpayments)
• Respond to provider and client inquiries regarding the reasoning behind an overpayment

Lagrange, KY

• Pursues recovery of pharmacy claim overpayments through outreach to PBM’s, insurance carriers, employer groups, and hospice and dialysis facilities
• Educates payers on requirements for reimbursement of overpayments associated with coordination of benefits, including Medicare Secondary Payer requirements, as well as Hospice and ESRD drug exclusions under Medicare.
• Monitors all outstanding payer recoveries and performs follow-up calls to payers to assure timely reimbursement for clients

La Grange, Kentucky

• Coordinate claims between Medicare Parts B, D, and commercial insurances
• Review data given to us from our clients and use it to investigate other insurance coverage a member might have that could be the primary insurance to our client
• Contact the other insurance or prescriber to gather the necessary information needed to determine primacy based on state and federal regulations

Lexington, Kentucky Area

Accepted prescriptions from patients. Entered data into a computer. Insurance billing (including Medicare and Medicaid). Communication with doctors and insurance companies. Customer service. Inventory management.

Bachelor Of Arts (B.A.), Sociology

Education record