Self Funded IndustryReference Based PricingAuditing both CMS/UB-04 Medical ClaimsCoordination of MS Products for accuracy.Applying standardized coding rules, guidelines and conventions.Entering billing information into the appropriate report format.Reviewing contracts and applying contractual adjustments to charges being billed.Auditing charges for CPT coding and compliance through the rules based system of state and federal regulations.Process and Access coding patterns and be able to identify signs of fraud and abuse.Escalating discrepancies and system issues to higher management.Reviewing medical records to verify accurate coding.Meeting accuracy of work product.Proficient in meeting quality and quantity standards.Learning and properly utilizing proprietary software programs essential to support the job function.Adhering to HIPAA guidelines and regulations.

Data EntryClaims IntakeUB-04/CMS-1500Audit Issues for AppealsAudit Issues for BBClaim TriageClaim InquiriesTPA CoordinationOnboarding MentorClaims ResolutionFollow UpProject ManagementContract VerificationHandling and Identifying Replacement/Corrected Claims/Duplicate ClaimsOperative Report CoordinatorItemized Bill CoordinatorNurse Review CoordinatorMedical Records CoordinatorMember Information VerificationThriving in a TeamThriving IndependentlyCoverage DeterminationFast Paced and Innovative EnvironmentEOB VerificationEfficient Acclamation to Systems and Softwares

Assisting families experiencing Childhood Cancer of exclusively attending and volunteering in Philadelphia Region.