Use investigative tools to locate debtors who have gone delinquent on the their car paymentsInvestigate social media sites to help locate debtorsWork with towing agencies to have the vehicles repossessedWork with the credit lenders to help the debtors work out arrangements

Pricing Analytics & Contract Configuration 2014 to 2015 El Dorado Hills, CAProvider Dispute Resolution 2013 to 2014 Appeals & Grievance Coordinator 2012 to 2013 Senior Clinical Support Coordinator 2004 to 2012 Business Information Analyst 2002 to 2004Claims Review Representative 2000 to 2002 •Responsible for managing complex pricing structures •Negotiate provider pricing provisions for all contract types, product specific pricing, network pricing structures, and associated fee schedules •Researches and resolves member/subscriber grievances, appeals and complaints, claims issues, and interprets and explains health plan benefits, policies and procedures to respondents. •Process hospital and skilled nursing admissions and discharges and document in the claims system.•Monitor duration of hospital stay for scheduled surgery and emergency admits•Process individual and family plan applications with varying degrees of complexity within appropriate processing guidelines •Access and update complex computer screens•Research information as appropriate to resolve problem encounters•In depth knowledge of ICD-9, CPT and HCPCS coding•Assisted with system desktop issues•Process security requests for new hire Exam Id’s, LAN and TPSU access•Organized and executed all desktop moves•Managed claims inventory to meet regulatory turn around times and produced inventory reports to Senior Management•Manage Medical Review Advisory Department data base•Interpret and apply the clinical decision to the claim for adjudication•Trained to data enter and process professional claims to payment resolution