Michael Dew Email & Phone Number

Greater Chicago Area

Greater Chicago Area

Greater Seattle Area

Trouble-shoot application issues raised by users.Code changes to the COBOL application, as requested by users.Write COBOL programs with embedded SQL to support client reporting needs and to comply with state and federal laws.

Greater Seattle Area

Trouble-shoot application issues raised by users.Code changes to the DB/C application, as requested by users.Write MySQL queries and stored procedures to support client reporting needs and system conversions.

Trouble-shoot application issues raised by users.Code changes to the DB/C application, as requested by users.Write MySQL queries and stored procedures to support client reporting needs.

Convert existing clients and implement a new client to new Health Claims Processing Systems.

Define business requirements for converting existing clients to a new Health Claims Processing System (HCPS). Configure Plan settings to match business requirements.Trouble-shoot improperly adjudicated claims scenarios identified by business users of a legacy HCPS. Correct such scenarios by adjusting plan configuration settings and/or sections of the.

Performed testing tasks for implementation of a new Claims Processing System (CPS), including designing, developing and executing test plans to validate system functionality.Configured rule-sets replicating the CPS' claims adjudication logic in the Fico Blaze Advisor business rules engine. Coordinated and conducted rule-set testing. Debugged defects in.

Performed testing tasks for implementation of a new Claims Processing System (CPS), including designing, developing and executing test plans to validate system functionality.Increased QA testing efficiency by initiating and taking the lead on design and development of a semi-automated testing procedure, compatible with the new CPS. This included working.

Reviewed and analyzed questionable medical and disability claims using medical documentation, correct coding guidelines and physician-approved Policies and Procedures. Consulted with independent medical consultant as needed.Reviewed charges denied by an outside vendor's claims editing software when questioned by the billing provider. Utilized CMS and CPT.

Processed preauthorization of benefits requests and appeals of plan benefit determinations.Analyzed data to determine which appealed plan benefit determinations were processed in accordance with plan provisions.Prepared appeal packets used by both the internal appeals committee and the Board of Trustees in reviewing the appeal.Communicated preauthorization.