John Patrick Fernando, Clssgb Email and Phone Number

-Communicated with insurance companies to assess claim statuses and meticulously analyzedExplanation of Benefits (EOBs) for discrepancies.-Investigated denied claims by meticulously reviewing EOBs and utilizing healthcare systems suchas EPIC to pinpoint denial reasons and facilitate resolution.-Conducted thorough checks on claims for completeness and accuracy, diligently maintaining andupdating records to ensure no cases fell through the cracks.-Reviewed claims for processing accuracy, collaborating closely with healthcare providers andcoding specialists to rectify discrepancies and ensure precise claim submissions.-Analyzed reports on claim status, aging, and payment trends to uncover opportunities for processstreamlining and error reduction.-Maintained up-to-date knowledge of insurance regulations, coding guidelines, and industrystandards to ensure compliance and accuracy in claims processing.-Prepared and submitted appeals for denied claims, adhering rigorously to specific proceduresoutlined by insurance companies and regulatory bodies.-Participated actively in team meetings to address challenges, share best practices, and implementstrategies aimed at enhancing claims processing efficiency.

-Reviewed disputed signatures for appeal letters and assist infinding any discrepancies.-Acquired necessary information to thoroughly analyze, investigateand provide a clear and concise explanation of why a claim wasdenied or how a claim was adjudicated within strict timeframes.-Ability to read, interprets, and analyzes documents such asreports, guidelines, plan documents and summary plandescriptions.-Researched and resolved payment related issues and properlyidentify root cause of appeal.

-Adjudicate claims-Initiating or conducting investigations of questionable claims-Resolves claims by approving or denying, calculating benefit due,initiating payment, preparing notice to member after caseadjudication by indicating remarks in the system-Performs second layer checking of claims proposed by juniorassessors.

• Understands and resolves client work queues which include but are not limited to: claim denials/rejections for authorization, medical necessity, duplicate, timely filing, COB.• Reviews and corrects all claim charge denials and edits that are communicated via Vipr, or other systems, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to share in the education of fellow team members, to expedite the recovery of future denials and edits of the same nature.  Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution and payments. Ensuring that department and customer needs are met, and assisting with special projects, as needed.• Reviews claim forms for the accuracy of procedures, diagnoses, provider and patient information, as well as all other fields on the HCPCS and UB-04.• Handling special accounts like Medicaid, Baltimore, and Ascension

Providing administrative , clerical, and financial reportsRecord and manage membership records

Engage and interact in people with diverse cultureSupervise at least 24 people also serving as fulltime missionaries