Judith N. Email & Phone Number

Orange County, California, United States

• Performs Supervisor’s task when a Supervisor is absent
• Assists Trainer for review; updated/modified Crossover Desktop processing guidelines
• Monitor and delegates aged claims to staff via email to bring down the inventory to meet Turn-Around-Time (TAT 95% and above)
• Collaborates with IS team to prevent system error in claims processing
• Reviews triage and processes Letter of Agreement (LOA), reviews transplant multi-million dollar claims
• Handled government cases: Triage case, concluded summaries, and provided all supporting documentations to Legal Department in a timely manner

Santa Ana, California, United States

• Processed Officeally and Image claims, manually input information into Eldorado system. (80+)
• Validated providers PPO plan using First health and PHCS program.
• Analyzed claims for possible duplicates, pre-existing conditions, member's coverage and termination dates and other secondary insurance. Sent letters to members for accidental details and pre-existing information.

Irvine, California, United States

• Processed Edi (Electronic) CMS 1500 form claims; Data entry paper claims into HPCS -UNIX system.(80+ claims) manually / (Medi-Cal, Medicare EOB, Dental and Vision Plans).

Irvine, California, United States

• Reviewed, analyzed, solved and processed CMS 1500 form claims into EZCap system in a timely manner. (150+ claims) (Medi-Cal and Medi-Care).
• Utilized PSD form (Provider Service Data) to update provider's correct information into database and benefit tables appropriate to the member's health plan.
• Investigated reject files identified corrected any issued claims that can be processed in timely manners.
• Verified claims for correct IPA database and distributed to proper claim examiners. (Medi-Care, Medi-Cal / Healthy Families/Healthy Kids, Commercial & POS).