Irma Sanchez Email & Phone Number

Richardson, Tx

Responsible for reviewing non-standard contracts for system capacity, implementing & auditing contract completion, handling contract inquiries by conducting research & coordination through various departments in resolution & responding to inquiries, conducting contract analysis & modeling, conducting quality control & analysis of quality reporting, preparing quality improvement recommendations, & develop documentation & training materials. Also web maintenance for BCBS web portal.

Frisco, Tx

Under the general supervision of the Reimbursement Supervisor / Manager, is responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved. Collects & reviews all patient insurance benefit information, to the degree authorized by the SOP of the program. Provides assistance to physician office staff & patients to complete & submit all necessary insurance forms & program applications. Completes & submits all necessary insurance forms & electronic claims to process the claims in a timely manner. Researches & resolves any claim denials or underpayment of claims including electronic claim denials. Effectively utilizes various means for collections. Provides exceptional customer service to internal & external customers; resolves any customer requests in a timely & accurate manner; escalates complaints accordingly. Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, & case managers. Reports any reimbursement trends/delays to supervisor. Processes any necessary insurance/patient correspondence. Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, NPI number, & referring physicians. Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process. Maintains confidentiality in regards to patient account status & the financial affairs of clinic/corporation. Communicates effectively to payors &/or claims clearinghouse to ensure accurate and timely electronically filed claims. Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.

6611 North Beltline Suite#100 Irving, Tx 75063

Responsible for the timely, accurate submission of invoices to responsible payer, of any type, for all services and products provided. Evaluates payments received and application to the patient account. Follows-up with responsible parties to ensure the receipt of timely, accurate payments. Assists with Billing and Collection Training and completes "second level" appeals to payers.Submits timely, accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are correctly authorized and that required documentation is on file. Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.Evaluates payments received for correctness and applies payments accurately to the system. Verifies that payments received are correct according to the fee schedule. Applies the payment correctly to the patient account. Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment. Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service. Transfers payments belonging to other offices within 48 hours of receipt.Follows up on invoices submitted to ensure prompt and timely payment. Calls to verify that claims submitted were received and are in processing. Sends letters to the patient or responsible party when their insurance carrier fails to make payment reasonable time frame. Generates and mails statements and collections letters per Walgreens policy. Follows-up on all denials within 48 hours of receipt.

Frisco

Maintains exceptional service and integrity with customers and client accounts through accurate, timely, relevant, and quality work efforts of all inventory assigned to the self pay billing revenue cycle and call center. Drives inquiries from customers and clients towards resolution which includesthe identification of the appropriate source of payment or assistance program. Records and maintains complete and accurate documentation of all activity performed on appropriate medium.Informs management of operational issues impeding performance or customer satisfaction including but not limited to those impacting the customer, client, or the company. Documents all collection activity; maintains and organizes unit and responds to all correspondence, communication and/or verbal inquiries from all relevant parties. Understands and adheres to all policies and procedures, as well as local, state and federal regulations, relevant to their area of operation.

This position has the sole responsibility (100%) of answering incoming calls from providers and members as they relate to eligibility, benefits, claims, and authorization of services. Recognizes this is a frontline service position providing assistance to Magellan’s members and providers regarding programs, policies, and procedures. Responsible for problem-solving and explaining Magellan’s programs and procedures to callers. Also responsible for the administrative intake documentation in the appropriate systems. The overall expectation of the CSR II is to provide outstanding service to our internal and external customers and to assist in mentoring new CSR’s. In addition, the CSR II must have achieved an overall performance rating of meets or exceeds standards on their formal review as a CSR I.

Dallas/Fort Worth Area

Process credit card payments for Texas Health Resources Hospitals on childbirth educational program payments. Responsible for data entry of childbirth education and other special program payments. Process childbirth education class refunds. Handled delinquent and reminder calls to customers on programs. Handle answering service calls for doctors’ offices and clinics. Assisted with the data entry of triage call for the Nurse Line program for a physician's offices and clinics locally and nationwide. Assist customers with childbirth education and physician referral appointments. Assist customers with multiple Texas Health Resources Hospital programs.Responsible for crisis calls and continued assistance to a clinical staff until resolved. Provide assistance to providers on multiple programs. Additional responsibilities as assigned and special projects by management staff.

Dallas/Fort Worth Area