Accounts Receivable Specialist/Medicare- Infusion Services, CVS Health, Phoenix, AZ. (November 2017-July 2018)• Assist in the resolution of denials, partial payments, and payment variances for Patient Financial Services (PFS) Maintain and release all-ship-verified claims for all third party claim accounts within established time frame as assigned, Resolve errors and make claim edits assigned in work queues, Credit/Recharge• Follow work list prioritization of accounts for resolving accounts and/or submitting claims, Contact payers and patients when necessary for PFS processes, written reopening’s and appeals• Request relevant information from appropriate Revenue Cycle and clinical departments as required through the course of the PFS processes - Make necessary adjustments to patient demographic, insurance, and account balance information, conduct QA audits, prioritize age buckets and specialty projects. Complete A/R adjustments, request other adjustments, build templates and instructional/informative PowerPoint presentations Adhere to all regulatory compliance areas, policies and proceduresPrevious employer Molina HealthcareReviews Processor II/ Claims Analyst, HR Assistant, Molina Healthcare, Albuquerque, NM. (April 2013-Feb. 2016)• Process all requests/approvals/denials regarding member PHI (Protected Health Information).• Format, review, and create Centennial Care Program P & P’s (Policy and Procedure forms).• Provide ongoing monitoring and serve as an advisory on compliance and potential fraud matters.• Participated with the Anti-Fraud, Waste and Abuse Program (FWA) & Govmnt. Contract team.• Train CRP’s, RN’s & LPN’s in CCR & PA (prior-auth) processes, prepared for & preside at NCQA audits. • Process CCR Medicaid & Medicare admissions, reviews, discharges and denials, Care Coordination. Assist in the claims flow processes, review and update claims. Prepare for appeals and CIR’s.