Hands on medical billing and appeals to ensure claims are processed in a timely mannerDevelopment of appeal templates for Workers Compensation billing teamWorks closely with payers, providers and patients to get accounts resolvedReview and audit explanation of benefits from Workers Compensation carriers to ensure claim paid correctly per the Connecticut fee schedule and does not need to be appealedProcess quality auditing and retraining of staff if neededCommunicate and coordinate with hospitals regarding billing procedures Review UB04 for correct revenue, CPT & ICD-9 and ICD 10 coding Review and audit medical records for submission to insurance companiesRun daily inventory details to ensure that the accounts are being worked in a timely manner and that high priority accounts such as high dollar or aged out don’t get missed.Calculate open inventory for monthly cash flow reportsDevelop training manuals and train new hires directly to ensure proper trainingComplete weekly Excel spreadsheets for hospital representatives to clean up accounts, and monthly Assist employers in filing a First Report of Injury with Workers' Compensation InsuranceInform patients of their rights in filing a 30C Claim with Commissioner in the event of a conflict with employerNegotiate payments, validate payments; Workers' Compensation Hospital & Practitioner Fee Schedule, PPO Contracts, CCI EditsCommunicate with established point of contacts (Insurance Claims and Bill Review Managers) for escalation of problem and high dollar accountsCommunicate with Attorneys and Workers' Compensation Districts on litigated casesCommunicate directly with Clients (Hospitals) preparing and submitting reports, implant invoice requests, hospital employee injuries, billing/coding issues, refund requests, payment transfers, and research requestsAssist staff and co-workers with questions and training Assist other Teams/Departments when backlogged

Billed and contacted various insurance companies for payment of medical claims.Sent written appeals to insurance companies for payment of denied medical claims.Billed no fault and workers compensations claims.Contacted debtors for payment of outstanding medical bills.Made contact with Medicare and Medicaid representatives.Contacted attorneys and their staff for follow up on a debtor’s pending litigation case.

Check processing; credit transmittals and voidsAnalyzed, calculated, and collected overpayments to providers and membersAudited Claims ProcessorsCustomer ServiceTrusted to handle sensitive projects and VIP accountsCross trained in multiple plansMember of the SWAT Team (Specialized Workflow Assessment Team)

Medical Claims adjudicationCalculated medical expense reimbursement to providersHandled VIP and Executive Medical accountsBack up to Overpayment and CBIA Units