Robin Workman Email and Phone Number

CMS Reporting Compliance -section 111 ComplianceAssisting with Medicare Compliance in the Settlement/Payment of Claims:• Acting as a resource for questions regarding protection of Medicare’s interests in the settlement of any claim• Provide assistance with the dispute of any CPN notices that are not related to the claim• Ensure the claims department is compliant on settlements/payments to meet the MMSEA guidelines for CMS• Monitor claims error reports to ensure reportable claims are being sent to CMS timely and accurately• Compile and forward SLU Quarterly submissions to be entered and submitted by ISO via iComply QA process and Onboarding and adjuster development • In a joint effort with the Ops team, evaluate and Revise Quality Review Process-- Progress made on items identified toimprove the QA process within expected timeframes• Explore and assist in facilitation of vendor audits • Work with instructional designer to develop training for new employees for the onboarding program on Medicarecompliance and adjuster development• Identify employees that may need additional training through quarterly report error review• Assist Field on any Medicare training needsQuarterly review of Adjuster Licensing for Compliance

Handle technical claim system issues as liaison between the field users and IT department. Act as Subject Matter Expert approving system updates for claim system (ClaimCenter by Guidewire).Serve as lead for vendor integrations of Cypress Care/Optum for Pharmacy Review and MCMC for Medical Bill Review. Handle EDI complex issues with vendor, Mitchell International. Support and maintain claims department system-ClaimCenter by Guidewire. Review and provide technical application and process support to users through the identification of business needs and system impacts.Identify and recommend system and/or procedural improvements based on existing operating information systems and procedures. Lead projects for new state Claims Electronic Data Interchange (EDI) implementations and coordination with EDI vendor-Mitchell International for EDI ongoing updates from IAIABC for EDI standards. States handled include TX, NY, VA, PA, MO, TN, IA, SD, MN, LA. Have handled both FROI and SROI states.Lead contact for third party integrations and other related special projects including requirement gathering, vendor project management, and coordination with internal departments.Create and distribute communication materials and conduct training via GoTo webinars or in person training on claims related applications, processes and system upgrades. Participate in requirements gathering with Business Analysts/IT staff to improve end user experience and maximize system functionality.Define, develop and implement quality assurance practices and procedures, end user test plans, scenarios, or procedures and other quality assurance assessments, ensuring timely resolution.

Handle all EDI transmissions to various states including TX, IN, SC, SD, IA, KY, TN, VA, NJ & NE. Monitor and reconcile State Claims EDI filings for finable and non-finable MTCs.Identify trends in EDI filings and provide training to adjusters to correct negative trends. Handle DCI reporting and manually enter data into NCCI website.

Supervised clerical support staff for Liability & WC Claims adjusters. Handled all aspects of clerical support including claim set-up, coverage requests, stop payments, claim transfers, scanning documents, mail functions, etc.

Managed the front office for 6 satellite office Neurology group. Managed scheduling for all 6 offices, as well as physician schedules for rotations to each office. Trained front office staff to run satellite office by themselves. Traveled to all offices once a week to check progress and workloads

Supervised Front Office staff for multi-physician Family Practice. Worked in Billing Dept handling patient accounts and insurance reconciliations.

Processed medical claims on multiple systems, assisted in audit department, assisted in customer service call center