Jimmie Greer Email & Phone Number

Plano, Tx, Us

United States

Dallas-Fort Worth Metroplex

United States

2017-Present Children's Medical Center Health Plan - Irving, TX – Provider Data Management Analyst• Provides reporting to assure compliance for all regulatory and accreditation body requirements.• Performs updates to provider records in the claims system for demographic and other changes utilizing QNXT, Cactus, NPPES, MPF, paper files, and P Files.• Develops, implements and drives best practices for claims adjudication in conjunction with claims and network contracting. Assuring… Show more 2017-Present Children's Medical Center Health Plan - Irving, TX – Provider Data Management Analyst• Provides reporting to assure compliance for all regulatory and accreditation body requirements.• Performs updates to provider records in the claims system for demographic and other changes utilizing QNXT, Cactus, NPPES, MPF, paper files, and P Files.• Develops, implements and drives best practices for claims adjudication in conjunction with claims and network contracting. Assuring provider details are entered, affiliated and contracted correctly to ensure a smooth process.• Identify and accurately analyze data file components to complete record set-up of practitioners and facilities, which may include credentialing documents, contracts, fee schedules, and other highly sensitive reports. Interpret and escalate data to ensure timely and accurate record set up.• Actively anticipate and report potential areas of concern within data and in consideration of downstream processes (claims, utilization management, enrollment, and provider network) for potential network inadequacies. 2016-2017 Children's Medical Center Health Plan - Irving, TX - Claims Analyst• Resolves medical claims by approving or denying documentation; initiating payment.• Ability to verify and understand claims on an 837 file.• Ability to match providers on an EDI file.• Processed all types of pended claims utilizing QNXT and CCA.• Always exceeded weekly production• Ensures legal compliance by following company policies, procedures, guidelines, and state.• Verify claims payment is correct based on Texas Medicaid & Healthcare Partnership rules and regulations regarding STAR KIDS.• Claims payment based on Texas Medicaid & Healthcare Partnership Fee Schedules.• Work appealed claims to ensure the resolution of the appeal is handled in a timely manner to ensure compliance with State Regulations. Show less