Sherese Hinton Email & Phone Number

Sterling Heights, Michigan, United States

Navigated multiple platforms capturing data/information necessary for processing medical claims; reviewed previously processed claims and executed adjustments after investigating issues or errors.• Processed an average of 1400 medical, physical therapy, Durable Medical Equipment (DME) claims, weekly• Demonstrated knowledge of Medicare and Medicaid reimbursement guidelines to determine correct billings and payments to avoid overbilling/overpayment• Applied knowledge of Waiver of Premium for disabled members/patients to determine eligibility for reimbursement of services• Completed necessary adjustments to claims and ensured proper benefits were applied to each claim by using appropriate processes and procedures and updated policy changes for patients• Reviewed claims for over-payments and generated over-payment letters for managing in network and out of network errors, incorrect billing from provider, etc.,• Utilized web-based tools, coding books, and other available resources to facilitate providing insurance companies with required information

Sterling Heights, Michigan, United States

Determined insurance coverage; examined and resolved medical claims; documented actions; ensured legal compliance.• Established proof of loss by studying medical documentation; assembled additional information as required from internal sources, schedule of benefits, and group notes; initiated or conducted investigation of questionable claims• Resolved medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letters• Documented medical reports/records, accident details, insurance details, appeal letters for accuracy in reporting, tracking, and management• Ensured legal and HIPAA compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations

Sterling Heights, Michigan, United States

Supported, developed, and maintained service relationships for provider with all participants; handled provider communication for accuracy in reporting.• Responded to electronic and direct inquiries from providers/clients/patients about policies, rates, changes, referrals, eligibility, credentialing, etc.,• Maintained provider documentation files; ensured all necessary documentation was complete and correct and updated/maintained provider databases

Sterling Heights, Michigan, United States

Reviewed and verified assigned codes and sequences diagnosis and procedures according to regulations (e.g., ICD-9-CM, CPT, HCPCS, UHDDS, and HIPPA coding guidelines) and entered all claim details into LuminX system.• Entered medical, dental, outpatient/inpatient claims; gathered demographic, insurance, and health care information from a variety of sources for the purpose of indexing for claims adjustment• Maintained up-to-date knowledge of coding and regulatory requirements to accurately assign codes for appropriate healthcare services for accuracy processing

Sterling Heights, Michigan, United States

Filed claims to hand off to adjuster for processing.• Safeguarded and protected patient's right to privacy by ensuring only authorized individuals had access to patient's medical information and that all releases of information followed request, authorization, company policy and HIPAA regulations