Assisted clients with applying and understanding the Sliding Fee Program, BadgerCare Plus, Affordable Care Act within a nonprofit community health organizationMaintained, confirmed and secured referrals, authorization information sent by physicians for medical services by completing patient account informationReceived and responded to all collection agency vendors, attorneys, or others concerning patient accountsWorked with a collection agency to refer patient accounts and report payments.Maintained interactions in the EHR/EPIC systemAccepted payments, set up payment plans completed daily site deposits and maintenance of site change fundsCollaborated with the Revenue Cycle and billing department regarding patient accountsReviewed claims, reprocessed billing info and updated patient insurance informationAnswer High Volume In bound call center line with regard to patient accounts, claims information, billing status and payment collections and arrangements, providing translation in SpanishMedical records prep, organization within hospital setting

Researched, investigated and resolved member appeals/grievances by obtaining data from multiple systems/vendors to ensure all documentation needed for appeal/grievance is obtained, and entered systems along with providing resolution.Collaborated with internal counterparts as needed to ensure proper handling of the appeal/grievance e.g., UM team, medical directors, claims, contact center, vendors as needed.Provided advocacy by supporting members with navigating their benefits, understanding of explanation of benefits and contacting pharmacies, providers and community resources including summary of payment information, prescriptions fulfillment and payor information.

Maintained, processed and amended 401K retirement accounts by providing customer service as a Pension Account Manager at MercerVerified health insurance benefits including completion of precertification of benefits for pre services by following up with providers and payers regarding referrals within Children’s Hospital system for members to seek care within the organization.Reviewed, Processed and submitted claims at Community Care organization.

Provided healthcare administrative services by maintaining provider schedules, release of health information, submitted billing account information to payers and carriers within a clinical office setting, servicing pharmaceutical, pharmacy representatives, healthcare providers and managed care organizations, and carriers within a fast paste clinical environmentCollections of copays, deductibles, out of pocket cost, while post paymentsSet up payment plans, accounts receivable/collections referrals and updates to patient accounts with regard to prior authorization process, provider referrals and procedures approvals/denialsTriaged, answered, responded and resolved High Volume call center que with regard to patient medical records, health information, approvals for surgeries and procedures, by providing upmost HIPAA compliant customer service to third party payers, carriers, patients, providers of care, hospitals and pharmacies