Support the administrator of the company. Negotiate Third party subrogation medical liens. Investigate possible TPL claims and identify compensation recovery. Maintain relationship with 20+ HMO medical groups to recover TPL claims. Prepare monthly reports for clients. Familiar with ICD-10 and HIPAA compliance, medical reports and billing. Implement new client accounts. Create demographic reports to send inquiry letters to members. Train new employees.

Credential, audit and ensure quality assurance for hospitalists in 26 regions. Ensure Proper enrollment into Medicare and Medicaid and audit the credentialing team for quality and accuracy. Create tracking reports and conduct weekly audits. Work closely with the business analyst, claims and billing to analyze issues and solve problems in … Show more Credential, audit and ensure quality assurance for hospitalists in 26 regions. Ensure Proper enrollment into Medicare and Medicaid and audit the credentialing team for quality and accuracy. Create tracking reports and conduct weekly audits. Work closely with the business analyst, claims and billing to analyze issues and solve problems in various departments that affect the credentialing department. Show less

Credentials individual and/or facility & ancillary medical/surgical providers to ensure all credentialing standards and internal requirements are met and maintained. Verifies and maintains all network, individual, and/or facility/ancillary provider’s information. Monitors disciplinary actions and follows up accordingly. Corresponds with licensing board, hospitals, certification agencies, training programs, and medical groups to resolve any issues. Responsible for overall accuracy of… Show more Credentials individual and/or facility & ancillary medical/surgical providers to ensure all credentialing standards and internal requirements are met and maintained. Verifies and maintains all network, individual, and/or facility/ancillary provider’s information. Monitors disciplinary actions and follows up accordingly. Corresponds with licensing board, hospitals, certification agencies, training programs, and medical groups to resolve any issues. Responsible for overall accuracy of credentialing database. Assists in the preparation of file reports and binders for monthly credentials committee including pre-and post committee functions. Show less

Provide a high level of customer service. Maintain accurate eligibility records for assigned employer groups. Conduct periodic audits of group eligibility data. Reconcile group eligibility report to monthly statements. Enter on a daily basis system eligibility data: new enrollees, changes, and cancellations. Respond to all written and telephone eligibility inquires from assigned employer groups. Research information on subscribers to resolve problems and disputes. Maintains quality and… Show more Provide a high level of customer service. Maintain accurate eligibility records for assigned employer groups. Conduct periodic audits of group eligibility data. Reconcile group eligibility report to monthly statements. Enter on a daily basis system eligibility data: new enrollees, changes, and cancellations. Respond to all written and telephone eligibility inquires from assigned employer groups. Research information on subscribers to resolve problems and disputes. Maintains quality and production standards as outlined by the department. Mentor new hires with their book of business. Manage the the UC of California account for all 23 campuses thru out California. Process the monthly full file within a 5 day or less turn around. Maintain the dedicated urgent mailbox with requests from both Customer service and UC group representatives. Process and distribute reports on a Team level and input numbers into a database on a monthly basis. Show less

Take inbound calls scheduling and arranging diagnostic exams for workers comp victims. Update Claims adjusters and doctor’s offices of the progress of the patient’s appointments.Work closely with the Sedgwick Workers comp insurance company on making appointments and following up with the exams.

Manage and Maintain excellent customer service in the copy and print department. This included taking orders in house and over the phone for copy and print jobs. Help customers design their letterhead, business cards and envelopes for their business. Manage and operate several copy and print machines along with other machines such as the electric cutting machine, laminating machine, and binding machine. Update the daily sales data base to keep track of productivity to meet the… Show more Manage and Maintain excellent customer service in the copy and print department. This included taking orders in house and over the phone for copy and print jobs. Help customers design their letterhead, business cards and envelopes for their business. Manage and operate several copy and print machines along with other machines such as the electric cutting machine, laminating machine, and binding machine. Update the daily sales data base to keep track of productivity to meet the daily sales quotas. Show less