Olga Denis E. Email & Phone Number

United States

United States

Determined potential overpayment recoveries for multiple insurance companies by preparing effective data mining reports. Steered collaborative efforts in creating new ideas for new concept and recoveries. Updating and developing new and current audit recovery reports, developing and running custom queries. Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings.

United States

Maintain high-level quality standards by managing all inventory. Enhance customer loyalty by supplying excellent services. Develop long-term relationships by directing contract negotiations with new business partners. Drive business success by attaining operational goals as well as managing day-to-day operations. Facilitate decision-making by participating in regular meetings with business partners.

Greater Boston Area

Determined potential overpayment recoveries for multiple insurance companies by preparing effective data mining reports. Ensured maximum accuracy by verifying data through utilization of different software and pricing tools. Steered collaborative efforts in creating new ideas for new concept and recoveries. Identified and resolved queries by monitoring new weekly reports.Achieved and surpassed monthly recovery budget goals by delivering substantial contributions.Developed reports with… Show more Determined potential overpayment recoveries for multiple insurance companies by preparing effective data mining reports. Ensured maximum accuracy by verifying data through utilization of different software and pricing tools. Steered collaborative efforts in creating new ideas for new concept and recoveries. Identified and resolved queries by monitoring new weekly reports.Achieved and surpassed monthly recovery budget goals by delivering substantial contributions.Developed reports with valid recoveries by rendering expertise in analyzing contracts, client’s policies, and Medicare guidelines aimed at defining issues and developing criteria.Enhanced knowledge of new team members on QC written claims by conducting training sessions. Show less

Greater Boston Area

Owned control over investigation of potential recoveries for company via phone calls, questionnaires, claims, provider inquires, and other methods. Collaborated with attorneys and medical providers to lead and conclude lien settlements. Expertly processed personal injury, worker's compensation, and slip/fall claims through detailed research. Coordinated accurate processing of CMS-1500 and UB-04 in line with current policies and procedures. Checked investigational reports to recognize and… Show more Owned control over investigation of potential recoveries for company via phone calls, questionnaires, claims, provider inquires, and other methods. Collaborated with attorneys and medical providers to lead and conclude lien settlements. Expertly processed personal injury, worker's compensation, and slip/fall claims through detailed research. Coordinated accurate processing of CMS-1500 and UB-04 in line with current policies and procedures. Checked investigational reports to recognize and follow-up on members with additional insurance policies. Identified respective payers for individuals with more than one insurance policy. Entrusted with receiving and screening Spanish speaking calls by demonstrating exceptional communication skills.Improved team performance, collaboration, and accountability by providing innovative ideas to Manager.Developed process of logging all documentation received within two days and resolved member reimbursement within five business day upon receiving all documentation needed.Played a vital role in attaining and exceeding yearly monetary goal of $30M. Show less

Greater Boston Area

Processed all member reimbursement requests based on the member’s benefit. Monitored all incoming e-mails from escalated clients and resolved claims issues within requested timeframe by participating in Manager’s meetings. Prepared and checked all high-dollar claims. Improved skills by coaching new hires on all types of claim editing.Streamlined member reimbursement claims procedures by implementing efficient process. Improved 99.62% quality score through implementation of best… Show more Processed all member reimbursement requests based on the member’s benefit. Monitored all incoming e-mails from escalated clients and resolved claims issues within requested timeframe by participating in Manager’s meetings. Prepared and checked all high-dollar claims. Improved skills by coaching new hires on all types of claim editing.Streamlined member reimbursement claims procedures by implementing efficient process. Improved 99.62% quality score through implementation of best practices.Prioritized and resolved complex issues to strengthen relationship among various departments. Show less

Greater Boston Area

Collaborated with other departments, while serving as a primary resource for network providers and associated staff to rectify operational issues through implementation of new ancillary provider units. Responded to client emails and solved issues within requested timeframes.Developed mutual understanding and met desired expectations by documenting and maintaining records related to dialogue with assigned providers.Reviewed old contracts archived in cabinets and updated necessary… Show more Collaborated with other departments, while serving as a primary resource for network providers and associated staff to rectify operational issues through implementation of new ancillary provider units. Responded to client emails and solved issues within requested timeframes.Developed mutual understanding and met desired expectations by documenting and maintaining records related to dialogue with assigned providers.Reviewed old contracts archived in cabinets and updated necessary information (contacts, rates, payment methodology) for all contracted Durable Medical Equipment providers that helped other departments in accessing essential information to perform the job. Show less

Greater Boston Area

Greater Boston Area