Mackenzie Decourcey Email & Phone Number

• Claims Analysis: Lead the comprehensive review, analysis, and evaluation of complex healthcare claims to ensure accuracy and compliance with policy provisions and regulatory requirements.• Contractual Review: Analyze contractual agreements to determine the financial obligations and verify adherence to payment terms.• Overpayment Resolution: Drive the resolution of overpayments by utilizing in-depth investigations and identification processes based on relevant claims information, policies, and regulations.• Provider Interaction: Address concerns, inquiries, and appeals from healthcare providers regarding claims, demonstrating a thorough understanding of medical billing and reimbursement processes.• Quality Assurance: Establish and implement quality assurance measures to enhance claims processing accuracy and efficiency.• Policy Adherence: Ensure strict adherence to internal policies, external regulations, and industry best practices.• Documentation Management: Oversee the maintenance and organization of claims documentation, ensuring accessibility and completeness.• Training and Mentoring: Provide guidance and mentorship to junior claims analysts, facilitating their professional development.

• Claims Processing: Review and analyze healthcare claims to ensure accuracy, completeness, and compliance with policy provisions, regulatory requirements, and industry standards.• Documentation Verification: Verify patient and provider information, ensuring proper documentation for claim submission.• Overpayment Resolution: Investigate and resolve overpayment issues by analyzing claims data, policy provisions, and relevant regulations• Coding Analysis: Assess medical codes assigned to procedures and services, ensuring adherence to coding guidelines and accuracy in claims coding.• Communication: Interact with healthcare providers, insurance companies and internal stakeholders to address inquiries, resolve issues, and ensure timely claims processing.• Policy Adherence: Stay updated on healthcare regulations and policy changes to ensure compliance in claims handling.• Quality Assurance: Implement and maintain quality assurance measures to enhance compliance in claims handling.• Reporting: Generate and analyze reports related to claims processing, identifying trends and areas of improvement.