Julia Taylor, Cpc, Coc Email & Phone Number

Leland, NC, US

Remote

· Confirm medical benefits by reviewing existing benefits documentation, pertinent contract language, and researching state and federal regulatory guidelines· Reduce claims expenditures by validating benefit grids and compiling configuration gap analysis for proper configuration of claims processing software· Resolve discrepancies found within benefit grid.

Durham, NC (Teleworker)

• As a quality auditor I was responsible for performing quality audits of high dollar claims (CMS 1500 and UB04) on a prospective and/or retrospective basis, to ensure processed claims were in compliance with.
• maintaining reports, auditing tools, databases and related documentation.
• identifying root causes and associated error trends to determine appropriate training needs and suggest modifications to policies and procedures.
• maintaining employee/insured confidentiality.
• serving as a QA Department representative at internal and external meetings, document and present findings to QA Staff.
• working as a team player and communicating in a positive manner with co-workers, managers and other contacts, as well as being able to work autonomously

Remote

• Conducted individual quality assurance performance reviews of 15-30 staff members across several different lines of business and health plan products
• Provided feedback and coaching to claims professionals on auditing findings to promote collaboration and to ensure correct claim processing
• Assisted in the planning and implementation of solutions to improve the claim payment process, including recommendations for system changes and policy/procedure updates

Plano, TX (Remote)

• Researched and performed claim payment adjustments for Medicaid & other lines of business resulting from contract updates, including claims that required Coordination of Benefits
• Audited & corrected data errors as detected
• Achieved joint effort, production, and value standards to guarantee timely and accurate claim processing
• Reviewed, researched, and processed complex claims utilizing the follow programs/systems: Diamond 950, CareOne, Knowledge Library, Kana IQ, iDRS, HTDU Utility, and the ARU Tool

Durham, NC (Teleworker)

• Processed professional and facility claim forms, adjudicated for provision of deductibles, co-pays, co-insurance maximums and provider settlements
• Manually entered claim data into system when necessary
• Performed peer audits and audited randomly selected claims to ensure quality processing
• Followed adjudication policies and procedures to ensure proper payment of claims
• Delivered timely service to the members and providers on the subject of claims

Education record

An accelerated boot camp offered by my previous employer, BCBSNC, to help those interested gain the knowledge necessary to pass the AAPC.

Crc Certification

A self paced course utilized to provide a broad and in-depth review of all relevant information pertaining to Risk Adjustment in all.

Education record