Freda Harper Email & Phone Number

United States

Built Network agreements in Facets NetWorX, using Medical Agreement configurator, for facilities and providers and created test claims for expected results and accuracy.Ran claims reports in ACCESS to ensure claims are processed promptly by assigning network agreements to provider records or agreement builds.Audited 100+ contracts for facilities and providers daily for rates and fee schedules to determine pricing.Researched state files for hospitals, Rural Health clinics, and federally qualified clinics to verify rates and make updates when needed.Reviewed and adjudicated 500+ claims daily with payment totaling over $20K+.

Assigned pricing agreements for participating / non-participating provider records for claim processing.Examined over 20+ provider contracts in Macess daily, assigning correct pricing according to contract’s rate sheet.Analyzed claims for errors and made corrections, providing records for incorrect valuation.Developed pricing agreements for non-participating rural and federally qualified health clinics.

Built provider, facility, and group records based on the provider’s credentialing application and delegated rosters.Updated providers credentialing status once the credentialing process was completed.Processed return mail, PCP assignments, provider terminations, capitation payments, correspondence and appeals, and quality reports.

Provide telephonic assistance to members and providers.Assist providers with claims inquiries, appeals, and authorizations.Assist members and providers with eligibility status and benefits inquiries.Verify the member’s primary care physician.

Provide telephonic assistance to members regarding benefits.Assisted members with benefits inquiries and eligibility status.Assisted members with PCP changes.Upon request, mailed out provider directories, member identification cards, handbooks, and HIPPA forms.Assisted members with Explanations of benefits inquiries.

Bachelor'S Degree, Accounting

Bachelor Of Science (Bs), Accounting