• Database maintenance of accurate provider data, reporting and extracting data for various reports for database improvement. • Coordinated and organized corrective activities to clean databases and retain users, managed communication processes with other departments regarding database improvements.• Conducted provider demographic audits and provided feedback to reduce errors and improve processes and performance by outreaching to facilities, physicians, and physician management teams. • Prepared clear and concise reports that include audit findings, conclusions, and resolutions.• Maintained current provider data to ensure the quality of the network by implementing daily goals and creating a work flow policy to ensure goals were met and/or exceeded.• Evaluated weekly performance data reports to develop methods to improve performance of team members and meet national team goals.• Provided technical assistance to team members regarding policies/procedures to ensure work is submitted accordingly.

• Designed and implemented programs to build and nurture positive relationships between the health plan, providers, and practice managers. • Managed over 500 physicians, offices, and facilities, to ensure the maintenance of accurate demographic information by applying pertinent data and facts. • Strategized and collaboratively worked with providers and practice managers to ensure their compliances with UnitedHealthcare and CMS regulations/requirements.• Assisted providers and/or practice managers with managing online applications. • Identified gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs.

• Managed a variety of projects assigned by supervisors/directors and ensured completion prior to deadlines. • Reviewed and validated accuracy of charges and codes before submission to insurance companies, including NJ Medicare/Medicaid to ensure timely filing and payment.• Processed payments to accounts by certifying payments received per contracts. Adjusted accounts per fee schedules, documented contract allowances, capitated, incentive, and enhanced payments.• Collaborated with supervisor to investigate and resolve insurance discrepancies’.

• Aided and supported clients with respect to variety of issues through services referrals.• Managed and facilitated parish bills and rental assistance program. • Interviewed and determined eligibility of families in need of financial assistance with utilities and back-rent. • Conducted advocacy work for non-English speaking individuals and families.

• Oversaw over 200 patient accounts on a monthly basis. Monitored account balances and correspondence between patients, insurance companies, and attorneys.• Assessed insurance explanation of benefits of bill and appealed any declinations to ensure proper payment. • Responsible for communication and written statements with legal attorneys regarding patient accounts and legal documents needed for successful billing and court trials. • Coordinated Doctor and patient schedules to maintain an appropriate and proactive appointment flow. • Translator for Spanish speaking patients during their appointments and examinations