Jeff Sheaffer Email & Phone Number

Philadelphia, Pa

King Of Prussia, Pa

Greater Philadelphia Area

Analyzed and resolved complex claims and provider issues. Accurately explained Health Partners policies and procedures to providers or their representatives. Promptly referred potential or identified problems to Claims Director. Consistently followed DPW and HCFA guidelines, policy and procedures with regard to system documentation requirements. Mastered MCS and Power MHS systems.

Greater Pittsburgh Area

Reviewed and resolved single and multiple suspended claims that required a high level of analysis, investigation and medical review. Updated independent databases and created and prepared reports. Acted as a contact to physicians and facilities to finalize cases and aide in resolving claims suspended in error. Priced all of-of-state Medicare claims.

Greater Pittsburgh Area

Processed medical claims in a timely manner that met and exceeded the production goals and quality standards. Utilized CPT-4, HCPCS-1500 and ICD-9 coding in daily functions. Processed both indemnity and managed care claims (PPO, PPA, HMO and POS).