Niko Mitchell Email & Phone Number

Greensboro Nc.

Adjudicate escalated claims which includes Medicare/Medicaid to resolve complex issues for team members and internal customers.Negotiate pricing per Providers contract as needed.Support implementation of updates to the current procedures and assist with new system training/mentoring.Review guidelines as well as benefit plan documents and certificates to ensure proper benefits have been applied to each claim.Analyze and identify trends and provide reports as necessary.Maintain required metrics of 80 plus claims per day.

Greensboro Nc

First Call Resolution for Customer inquiry about their Healthcare PolicyEducated Customers about the Fundamental and Benefits of their policy by guiding them with the value of their Health Plan and selecting quality care providers.Contacted Care Providers office on behalf of the customer to assist with appointment scheduling or connections with Specialist.Assisted Customers in navigating UnitedHealth Group websites while encouraging and guiding them to become self-sufficient in using these tools.

Winston Salem Nc

Adjudicated all claim types such as, complex, and high dollar which includesMedicaid/MedicareSkilled with working with Self-funded, Fully funded, Small groups along with City groupsProcessed adjustments to medical claims, voids, and refund requestGathered any additional information needed to complete the adjudication.Attached and processed correspondence that needed to be linked to appropriate claims, and member

Norfolk Va

Worked all claim reports as needed and assigned by managementAchieved daily metrics of 60-80 adjudicated claims dailyVerified all medical necessity guidelines were metDetermined all provider and member reimbursements were correct and resolved anynecessary adjustments

High Point Nc

Accurately processed medical and hospital claims in accordance with Aetnareimbursement policies and proceduresApplied medical necessity guidelines, determined coverage, completed eligibility verification and applied all cost measures to complete adjudication process.Achieved service goal of 15-20 adjudicated claims per hour.

Winston Salem Nc

Review and adjudicate 40-60 claims per hour for allocation of deductibles, co-pays, provider payments and member reimbursements. Refer claims for medical review as necessary. Recognize and resolve issues related to claim components such as dates of service, billing, revenue codes, and claim formatting. Documents and refers issues of concern to a mentor as needed.

Winston-Salem, North Carolina, United States

Answered 80-100 incoming calls in a call center setting and accurately document and update records in required systems. Follow up in a timely manner to ensure customer satisfaction.Use thorough knowledge of claims processing issues, gaps and inconsistencies in work flow.