Maria Dower Email & Phone Number

High Ridge, Mo, Us

North

Manage and coordinate 5 teams within the Claims Department.Handle escalated claims issues internally and externally.

St. Louis, Mo

* Process medical, dental, Medicare and vision claims* Enter data into the Qicklink system* Adjust claims as necessary and take in full and partial refunds* Keep employee/dependent and claims notes updated* Answer inquiries from employees, providers and employers. Complete necessary follow-up action to resolve the inquiries* Organize work flow to meet office turn-around time requirements* Maintain production and audit standards as established by TriZetto

Homewood, Il - Remote

Supervise a team of 23 medical claims examiners. Duties include managing the backlog and assisting the examiners and team leads in the processing of claims. Responsible for handling internal and external questions from other departments as well as clients and brokers.

St. Louis, Mo

* Understand and accomplish essential tasks required to process medical, dental, Medicare and vision claims* Analyze claim data, including: pre-existing, experimental and investigational, eligibility requirements and coordination of benefits coverage* Train and assist examiners on processing of claims* Auditing of claims* Review and respond to requests for pre-determinations and appeals* Follow-up internally and externally as needed to meet all production and audit… Show more * Understand and accomplish essential tasks required to process medical, dental, Medicare and vision claims* Analyze claim data, including: pre-existing, experimental and investigational, eligibility requirements and coordination of benefits coverage* Train and assist examiners on processing of claims* Auditing of claims* Review and respond to requests for pre-determinations and appeals* Follow-up internally and externally as needed to meet all production and audit standards* Adjust claims as needed and take in full and partial refunds* Price PPO and HMO claims as well as refer claims to outside sources for pricing and negotitation* Adhere to Healthcare reforms* Assist Stop-Loss department as necessary* Obtain additional information from inside and outsides sources as needed* Assist in testing benefit structures* Process claims for overflow projects as needed Show less

St. Louis, Mo

* Understand and accomplish essential task required to process medical, dental, Medicare and vision claims* Analyze claim data, including: pre-existing, experimental and investigational, eligibility requirements and coordination of benefit coverage* Obtain additional information from internal and external sources as necessary* Adjust claims as needed and take in full and partial refunds* Keep employee/dependent and claim notes updated* Answer inquires from employees… Show more * Understand and accomplish essential task required to process medical, dental, Medicare and vision claims* Analyze claim data, including: pre-existing, experimental and investigational, eligibility requirements and coordination of benefit coverage* Obtain additional information from internal and external sources as necessary* Adjust claims as needed and take in full and partial refunds* Keep employee/dependent and claim notes updated* Answer inquires from employees, providers and employers. Complete necessary follow-up to resolve the issue Show less

St. Louis, Mo

* Understand and accomplish tasks required to process PPO and HMO claims* Pricing of HMO and PPO claims* Verification of reports

St. Louis, Mo

* Entering insurance and medical information into the computer system* Logging specimen into the system to correspond to the correct patient* Locate and correct data entry errors or report them to supervisors* Resolved garbled or indecipherable messages using the scanner

St. Louis, Mo

* Scheduling of patient appointments in the office and at surgical facilities* Billing of patients and insurance and posting payments* Blood draws, x-rays and general assisting to the physician* Responsible for choosing the insurance and billing program and implementing the change from a paper system to an automated system

Registered Medical Assistant, Medical/Clinical Assistant, Graduated With Honors

Front Office, Clinical and Laboratory Skills

Introduction To Data Processing, A

Diploma, General High School Curriculum And Computer Programming And Operating

General High School Curriculum