• Assist in the preparation of Tax Returns• Customer Service to new and existing clients

Currently selected to move to the rework department to assist on rework claimsAnalyzes and approves routine claims that cannot be auto adjudicated. Apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication processCoordinates responses for routine phone inquiries and written correspondence related to claim processing issuesProofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment toolsAbility to maintain accuracy and production standards. • Analytical skills. • Technical skills. • Oral and written communication skills. • Understanding of medical terminology. • Attention to detail and accuracy. Efficient at creating RUMBA macros Efficient at creating Excel Spreadsheets Navigation of ePoliciesNavigation of RUMBA screens• Analyze and approves assigned claims. • Resolve issues involving claim adjudications. • Proof claims or referral submission to determine and apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.

Call center for FEMA, assisted with processing applications, inbound/outbound calls for FEMA victims in regards to status applications

• Participate in daily conference calls to help steer the business. These calls consist of daily queues, mail and scanning updates, hours per department. Inform network of any system issues that will cause the daily/weekly goal not to be met.• Complete the end of week validation process for production, hours and wages• Forecast volumes for short-term and long-term workflow planning • Ad-hoc reportiing analysis to pull relative data for reporting and analysis • Effectively and proficiently maintain files daily to ensure the volume/cost of business is accurate• Work as a team with developers to design, test, and maintain new interfaces to improve process and data reporting• Build daily operating plans from employee scheduling across all functional areas to meet business needsStaff scheduling, time off allocationsData AnalysisData Trends

• Keyed headers for new prescriptions/refills/renewals• Processed orders routed to Quality Assurance for review• Rotated in the Doctor Calling area to Doctor’s offices for clarification or missing data on prescriptions• Created Job Aides/SOP’s for new hires as needed• Assisted in new hire training• Processed payments to patient accounts