Working with clients to process provider enrollment forms through UNIX and FACT system and completing applications through PRDB (Provider Enrollment Database) once certification is completed. Research errors on enrollment forms and submit request for clarification on incomplete enrollment applications.Audit Benefit Plans to ensure that Summary of Benefits, copays and deductibles align with insurer grid of current coverage plans for In Network, Indemnity Plans and Out of Network providers and process EOB’s (Explanation of Benefits) through VBA Platform.

Supported divisional projects to include collecting data, perform analysis to produce routine and non-routine reports for system and escalated technical issues regarding enrollment tools. Provided technical support to internal and external stakeholders by answering questions, supplying information, training and other technical support on secured services platforms. SME (Subject Matter Expert) for Medicare Advantage staging and training agents and groups users on how to enroll eligible members into Medicare Advantage or Cobra Plans, Performed Regression and UAT testing on enrollment platform. Researched problems in assigned areas, evaluated possible corrective actions and recommended a solution for implementation in order to facilitate continual workflow for end users. Created and updated departmental job aids to assist with procedural guidelines. Utilized Salesforce (CRM) to generate reports and create escalation request for technical issues on enrollment tools.

Accurately coded a large volume of dental claims on a daily basis. Timely updated patient benefit information in the organization’s billing system. Verified accuracy of billing data and corrected billing errors through audit reports. Responsible for distinguishing and billing various insurance policies thorough understanding of Medicaid and commercial insurance practices.

Ensured that customers arrived safely and timely to their destination while creating customer satisfaction.

Tracked and facilitated problem resolution for all escalated technical issues with My Beaumont Chart. Provided EPIC/EMR education and support for internal and external users utilizing My Beaumont Chart, and ensured timely documentation and accuracy of a resolution within call tracking databases. Developed strong relationships with end user communities, customers and IT stakeholders.

Managed and corrected 834 error reports generated from healthcare enrollments in the Marketplace. Provided guidance, assistance, coordination and follow-up on complex problems and ensured resolution on enrollment issues in the healthcare marketplace. Worked closely with management to ensure escalation deadlines were met for healthcare enrollments according to the regulations and guidelines set forth by CMS.

Navigated various computer systems and databases, affiliated with Medicaid, Medicare, and commercial insurances. Resolved insurance discrepancies by contacting patient, family members, , Medicare MSP department (secondary payer) departments, Employer group HMO's, Workmen's Compensation and Blue Cross pre-certification areas for updates on treatment authorizations. Verified a patient's insurance plan and eligibility.Confirmed coordination of benefits and patient's financial obligation.Handled insurance questions and/or obtained information from various Henry Ford Health System areas including but not limited to clinics, physicians, and patients, attorneys, employers and outside agencies via telephone or mail.

Navigated and verified eligibility through various computer systems and databases affiliated with Medicaid, Medicare, and commercial insurances. Resolved insurance discrepancies by contacting patient, family members, and outside agencies in order to determine the patient insurance plans and eligibility. Verified coordination of benefits in order to determine payment responsibilities of patients.

Assisted medical records department by reorganizing and customizing patient record systems to become more accessible to personnel. Verified date accuracy of benefit period re-certifications of Hospice patients, and audited files to ensure proper medical documentation was enclosed in the medical record.Verified date accuracy of benefit period re-certification’s for Hospice patients and ensured that physician documentation and attestation statements accompanied the medical record.Audited files to ensure that all medical documentation was signed by authorized medical professionals and sent to assigned departments.

Conducted research on delayed record request from state agencies.Researched court reporting errors on criminal cases and contacted law enforcement agencies to update records.Generated reports of vendors in payment default and negotiated payment arrangements.Communicated with general public in order to answer questions, explain court actions and provided necessary paperwork in disposition of court proceedings.