Korbyn Pile Email and Phone Number

Network Finance and Filing

• Service Fund liaison and trainer for nine markets.• Claims evaluation based on PCP Capitation payment issues.• Troubleshoot AEP issues and communicate with various departments for resolution.• Review PCP groups through SharePoint live files to avoid payment issues produced by inaccurate information.• Interpret new contracts received from the market in preparation for the system load process.• Work with financial and management team to determine monthly capitation issues and resolutions.• Thoroughly construct new procedure/training documents for new associates and departmental use.• Review contested claims to verify accuracy of expensing according to the guidelines of the PCP contract.• Investigate all PCP/group data through CAP Run error reports and work toward timely resolution.• Arrange necessary training sessions for internal departments to improve processes and communication barriers.• Provide support to supervisor for various tasks and projects involving system enhancements and reporting.• Collaborated with APEX Process department to resolve system barriers and constraints.• Implemented efficient system load process for all Care Coordination fees to reduce monthly capitation issues.

• SF point of contact regarding productivity of 4 markets.• Load and maintain 62,152 total contract sequences with 40% engagement deals.• Research and resolve of any membership, provider, or contract issues.• Executed research process for CCPII tasks for all Service Fund associates as requested by management.• Update and maintain SharePoint market master information, MER Expansion sheet, One Note, and new contract PowerPoints for specified markets.• Thoroughly trained multiple associates to successfully maintain daily workload and quality.• Recipient of eight STAR awards for quality of work performed.

• Reviewed medical records to obtain additional information needed by other departments for coding before being submitted to CMS for payment.• Partnered with research and invoice teams to retrieve specific measures related to compliance programs such as HEDIS and STARS.• Worked special projects and assisted in implementing and streamlining processes within the department. • Formatted and implemented educational materials for new associates.• Verisk Health System and claims research expertise.