Justin Strawderman Email & Phone Number

Buffalo, Ny, Us

Buffalo, New York, United States

Buffalo, New York, United States

• Full cycle billing, claims processing including electronic claim submission and submission of paper claims as needed, payment processing and denial follow up. • Resolve denied claims via appeals, dispute unpaid (rejected) claims, and handle other issues with EOBs.• Highly proficient with EMR systems with a focus on Medent. • Running and working aging claim reports to ensure follow up and payment. • Negotiating claim payment from health insurance plans. • Advance knowledge in ICD, CPT and HCPCS coding. • Regularly exceed $2.7 Million monthly payment goal.• Handling claims payment disputes. • Personally responsible for managing 16+ provider accounts, and additional accounts when necessary.• Reconciling, balancing and managing account ledgers for 500+ patients. • Handling official correspondence.• Data entry• Claims investigation to correct payment issues and disputes.

Buffalo, New York, United States

• Negotiating payment between multiple insurances and ensuring correct carrier is making payment. • Exceeded departmental goals for all metrics across all years of service. Maintained one of the highest productivity scores in department while maintaining a 99%+ financial accuracy rating.• Highly proficient with multiple CRM systems. • Coordinate coverage between multiple health coverages, including workers compensation and no fault. • Accurate data entry and reporting. • Ensuring privacy laws are adhered to and HIPAA compliance. • In-depth knowledge of health insurance and health insurance products.• Claims adjudication and adjustments for medical claims. • Operate within CMS guidelines and best practices; familiar with ERISA and TEFRA/DEFRA guidelines. • Familiar with ICD, CPT, and HCPCS medical coding. • Maintaining and generating multiple weekly and monthly reports in Excel. • Experience with document generation software. • Experience with claims management software.• Inter-departmental collaboration and experience working as part of a team. • Managing high volume of personal cases and claims while also supporting department with phone coverage and claims processing. • Reviewing and interpreting medical provider notes for claims and case investigation. • Taking member and provider calls to assist with complex claims and benefits questions or issues. • Review basic legal requests and process accordingly. • Review SOPs for updates, corrections and restructuring.

Buffalo, New York, United States

• Handle confidential medical information and comply with all HIPAA laws and guidelines.• Handle member calls regarding claims issues, grievances, benefit questions, billing issues and enrollment issues.• Experience with commercial employer-based coverage, Medicaid, Medicare as well as self-funded and large group plans. • Communicate with doctor’s offices, and other insurance companies to: Coordinate coverages, request medical documents, verify eligibility and update records. • Interpreting medical benefits for members and coordinating with health care provider to verify coverages. • Data entry experience as well as claims processing experience with a focus on speed and accuracy. • Experience with phone based as well as web-based customer service. • Account troubleshooting for member online accounts. • Experience with multiple CRM systems and health insurance management systems. • Work with brokers and enrollment to solve enrollment issues. • Top performer in department, with continuous perfect quality scores and member feedback surveys.

Buffalo, New York, United States

• Fast and accurate data entry while on phones with clients.• Ensure all state laws and insurance regulations are followed.• Handling a high volume of calls per day while maintaining high customer service and quality standards.• Experience with multiple insurance systems for interpreting and updating coverage.• Experience with automotive insurance, including PIP/No Fault, UM, Liability and personal coverages. • Answering customer inquiries regarding insurance benefits, claims and rate changes. • Soft sell other lines of business including homeowners, renters and umbrella policies.

Wellsville, New York, United States

• Work with individuals with disabilities teaching them social skills, life skills and job skills.• Work with individuals and their families to create person centered goals and ensure individuals receive outstanding services that are tailored uniquely to their needs and interests.• Ensure patient confidentiality while handling sensitive information. • Maintain up to date and accurate documentation on services provided for billing and medical purposes. • Operate within CMS and Medicaid guidelines.

Pennsylvania, United States

• McDonald's Management Training• Staff scheduling to anticipate business needs and facilitate vacations.• Conducted interviews with prospective staff. • Managed inventory and handled ordering product. • Help coordinate community events, update promotional items, and maintain up to date advertisements.• Worked to improve the customer experience and resolved customer complaints effectively ensuring customer was satisfied.• Manage and position store crew to maximize store efficiency and the guest experience. • Maintain store records; ensure the store adheres to all rules and regulations.

Pennsylvania, United States

• Entered prescription, processed and counted. • Verified validity of prescription by contacting provider office.• Follow up with patient inquiries regarding prescription.• Managed both walk in and auto refill prescriptions.• Fast and accurate filling of prescription, ensuring fill time under 15 minutes. • Tracking and inventory of controlled substances.• Compliance with HIPAA, Medicare and other applicable guidelines.• In depth knowledge of medications; brand vs generic name, general use and interactions, possible side effects and guidelines.