Assigns appropriate modifiers, based on origin and destination of tripReviews and/or determines the appropriate primary source of payment as necessaryDetermines the Level of Service to be billed, based on supporting documentation on the PCRAssigns proper condition codes/ICD-10 codes/procedure codes into the Accounts Receivable Billing SystemAnswers billing phone line, monitors voice mail, and assist sstaff and patients with questions.Reviews and updates CPT & ICD codes as neededMaintains currency in effective billing processes and proceduresEnsures accurate and timely processing of all third party insurance, Medicaid, Private Pay, including special programs.Responsible for the timely and accurate submission of insurance/Medicaid for completed patient services. May submit electronically, by paper or other external third party systems.Maintains up-to-date knowledge of regulations and laws related to the insurance industry.Demonstrates HIPAA compliance and patient rights’ while providing outstanding customer service in person, by mail or on the phone.Assists in delinquent account reviewAnd various other duties or tasks as assigned and/or needed

• Coordinate and manage the RFP response preparation• Create draft materials for the submission and rough drafts of proposals• Gather and assemble all proposal information and prepare final proposal working with subject matter experts and administrative staff• Review outcomes of projects and solicitation responses for opportunities to improve results• Determine requirements, establish priorities and monitor progress for assigned projects

• Checked all incoming prior authorizations for correct dental codes, ensuring every key piece of information is received in order to reach a decision.• Researched important information on MaineCare Members and Providers regarding codes and procedures being authorized in MIHMS system.• Processed PA’s in QNXT and Venetica.• Managed work queues to be sure PA turn-around time is completed within 2 business days.• Worked directly with ALL MaineCare enrolled dental/orthodontia providers.• Made sure that each incoming prior authorization is coordinated correctly for the dental consultant. • Discussed PA’s with dental consultant and gathers all information needed in order to reach a decision.• Reached out to providers when missing information is needed or if any issues need to be discussed. • Tracked all incoming and outgoing x-rays and study models in a tracking database.• Mediated issues that arise between providers and dental consultant decisions concerning prior authorizations.• Filed all x-rays and study models alphabetically, incoming and outgoing in a specially formulated tracking spreadsheet• Coordinated meetings with dental/orthodontia providers

—• Telephone Reception, transferred calls through the switchboard——• Greeted, signed in and issued badges to all visitors——• Escorted visitors to conference rooms—• —Assisted with travel arrangements——• Ordered office supplies for various departments——• Assisted with stuffing and stamping mailings for various departments—• —Provided coverage for the mail room staff and/or company courier——• Alabama & West Virginia P&T support: reviewing, printing, collating and assembling clinical packets per contract requirements, formatting documentation, creating and printing binder tabs, managing the shipping process for multiple recipients——• Performed basic office duties, including label printing, typing and maintaining lists, preparing rooms for meetings, stocking supplies, copying, and faxing.——• Scheduled & coordinated meetings, interviews, appointments, events and other similar activities——• Provided filing and maintenance assistance for the Clinical Article Database——• Scanned and electronically filed documentation——• Directed incoming phone calls during regular office hours——• Sorted and distributed mail for the main office and to individual departments as needed