Justin Tomaszewski Email & Phone Number

Pittsburgh, Pa, Us

Pittsburgh, Pennsylvania, United States

ntoring/training new staff members. Employee schedules. On call rotation. Payroll. Collaborates with appropriate areas for hardware/software issues (R1 Forum Sharepoint, R1 Hub, Allscripts, Navinet, Accureg, etc.) Continued training as processes evolve to support day-to-day operations and system changes. Ensuring department has adequate supplies.

Pittsburgh, Pennsylvania, United States

ntoring/training new staff members. Employee schedules. On call rotation. Payroll. Collaborates with appropriate areas for hardware/software issues (R1 Forum Sharepoint, R1 Hub, Allscripts, Navinet, Accureg, etc.) Continued training as processes evolve to support day-to-day operations and system changes. Ensuring department has adequate supplies.

Pittsburgh, Pennsylvania, United States

Collects and ensures demographic information from patients is correct and up to date. Ensures insurance is current. Explains intricacies of insurance questions within ability. Provides copayment slip and explains benefits, point of service discount thoroughly. Processes payment for copayments when working in the office. Changes visit status when applicable for admissions. Partners with appropriate area as needed for resolution of problems.

Greater Pittsburgh Area

FBOA Claims Analyst specializing in Bluecard Home claims. Served in a Business Analyst and Business Process Analyst role. Primarily providing root cause analysis for claim adjudication issues. Root cause analysis was to determine if human error or system error. If human error, provided education and updated desk level procedures when appropriate. If analysis determined there was a system error, partnered with the appropriate staff for system error to be corrected. Production and Quality… Show more FBOA Claims Analyst specializing in Bluecard Home claims. Served in a Business Analyst and Business Process Analyst role. Primarily providing root cause analysis for claim adjudication issues. Root cause analysis was to determine if human error or system error. If human error, provided education and updated desk level procedures when appropriate. If analysis determined there was a system error, partnered with the appropriate staff for system error to be corrected. Production and Quality accomplishments for Claim Adjudication tickets. During 2016, 197 were completed and closed within the set parameters. Quality was 100% with customer satisfaction ratings of 4.5 out of 5 for the year.  During 2017, 318 were completed and closed a little over the set parameters for time. Quality was 100% with customer satisfaction ratings at 4.82 out of 5 for the year.  During 2018, 276 were completed within the set parameters. Quality was 100% with customer satisfaction ratings at 4.84 out of 5 for the year.Managed Benefit Coding clean-up projects. Tested claim adjudication to ensure accuracy of Benefit Coding changes. Deployed to claim adjudication staff for completion and managed the overall project for timeliness. Production and Quality accomplishments for Clean-up Projects. During 2017, 88 were completed successfully within the set parameters and quality was 100%.  During 2018, 70 were completed successfully within the set parameters and quality was 100%Provided claim support with project management teams for a variety of initiatives and system changes. Duties included: claim adjudication testing or testing support, provided insight as a BlueCard claim SME, created and/or updated desk level procedures in the Knowledge Center database used by claim adjudication staff and provided education to staff for system releases via Skype during presentation meetings using Power Point. \ Show less

Bluecard Home/Host/Worldwide customer service and claims lead. Managed and assigned daily work for Customer Advocates, Claim Processors and Claim adjusters based on staffing, volume and staff skillsets. Coached Claim Processors, Claim Adjusters, Customer Advocates, and other operational areas within Highmark for compliance with BlueCard claim adjudication guidelines. Mentored new Customer Advocates, Claim Processors and Claim Adjusters within the department.Reviewed third party vendor… Show more Bluecard Home/Host/Worldwide customer service and claims lead. Managed and assigned daily work for Customer Advocates, Claim Processors and Claim adjusters based on staffing, volume and staff skillsets. Coached Claim Processors, Claim Adjusters, Customer Advocates, and other operational areas within Highmark for compliance with BlueCard claim adjudication guidelines. Mentored new Customer Advocates, Claim Processors and Claim Adjusters within the department.Reviewed third party vendor fees for post service audit of providers of other Blue Cross Blue Shield Host plans. Verified accuracy of billing, that guidelines were followed, and that were was a savings on the claim.Adjudicated Highmark employee Negotiated Rate claims; handled Negotiated Rate Escalations.Partnered with departments for claim adjudication due to performance guarantees. Collaborated with Benefit Coding, Sales, Appeals, Medical Review, Functional Business Operational Analytics staff, SIU, Highmark Health Solutions IT area and other Blue Cross Blue Shield plans.Implemented a process for the incoming Claim Appeals sent from other Blue Cross Blue Shield Host Plans. Developed guidelines and new processes for CSAs that reviewed the Claim Appeals and Claim Adjusters that adjudicate claims. Reduced volume of open BlueCard Home Claim Appeals from 800 to less than 100.Created Desk Level Procedures for the Away from Home Care transition from the Utilization Management area. This allowed the information to be easily accessible to more employees in a timely manner. Show less

Greater Pittsburgh Area

Managed and assigned daily work for Customer Advocates, Claim Processors and Claim adjusters based on staffing, volume and staff skillsets. Coached Claim Processors, Claim Adjusters, Customer Advocates, and other operational areas within Highmark for compliance with BlueCard claim adjudication guidelines. Mentored new Customer Advocates, Claim Processors and Claim Adjusters within the department.Reviewed third party vendor fees for post service audit of providers of other Blue Cross… Show more Managed and assigned daily work for Customer Advocates, Claim Processors and Claim adjusters based on staffing, volume and staff skillsets. Coached Claim Processors, Claim Adjusters, Customer Advocates, and other operational areas within Highmark for compliance with BlueCard claim adjudication guidelines. Mentored new Customer Advocates, Claim Processors and Claim Adjusters within the department.Reviewed third party vendor fees for post service audit of providers of other Blue Cross Blue Shield Host plans. Verified accuracy of billing, that guidelines were followed, and that were was a savings on the claim.Adjudicated Highmark employee Negotiated Rate claims; handled Negotiated Rate Escalations.Partnered with departments for claim adjudication due to performance guarantees. Collaborated with Benefit Coding, Sales, Appeals, Medical Review, Functional Business Operational Analytics staff, SIU, Highmark Health Solutions IT area and other Blue Cross Blue Shield plans.Implemented a process for the incoming Claim Appeals sent from other Blue Cross Blue Shield Host Plans. Developed guidelines and new processes for CSAs that reviewed the Claim Appeals and Claim Adjusters that adjudicate claims. Reduced volume of open BlueCard Home Claim Appeals from 800 to less than 100.Created Desk Level Procedures for the Away from Home Care transition from the Utilization Management area. This allowed the information to be easily accessible to more employees in a timely manner. Show less

Greater Pittsburgh Area

Answered telephone calls from members, providers and other Blue Cross Blue Shield plans that had questions regarding membership issues, benefits, claims, spending accounts, medical policies, claim appeals, and provider network information. Specialized in Navinet and Blue Squared general inquiries. Performed simple claim adjustments.

Bluecard: Bluecard Scorecard, Invalid SF, Invalid DF, Invalid RF, Invalid SF2, Invalid DF2, SF Build errors, missing ABKs, DF Build Errors, SF no DF, DF no RF, SF2 bypass, etc. | All things BlueSquared: GI, MRR, Claim Appeals, etc. | IBM Cognos | Microsoft Office – Access, Word, Excel, PowerPoint, Sharepoint | Data Gathering and Detailed Reporting | Process Improvements | Critical Decision-Making | Complex Problem Solving | Resource Management