Theresa Philipson Email & Phone Number

Irvine, Ca

Santa Ana

Oversee/manage enrollment team responsible for assisting clients with payer enrollment during and post implementation. Train and support clients on the proper usage of online portal. Provide client with customer service support in all aspects of enrollment ensuring company standards for customer service are being met and maintained. Monitor team to ensure enrollments are maintained according to payer standard turnaround times. Maintain, monitor and report department metrics. Support on-boarding of full service clients including completing all aspects of the enrollment process except document signatures. Attend/host all new customer calls to address implementation concerns. Maintain detailed implementation project plan that included all information the client needed to ensure their 'go live' date was achieved. Set up reports in SalesForce to report client and staff metrics.

Lake Forest Ca

Oversee/manage team responsible for grievance and appeals related to payment discrepancies of HCFA1500 and UB04 claims according to provider contracted rates. Train and mentor staff with current/new processes, facility and professional contract interpretation, usage of current/new software and systematic enhancements or changes related to claims processing. UAT for system updates or enhancements. Identification of fee schedule and facility contract discrepancies that required escalation to appropriate departments for correction to ensure accurate processing during first pass through system. Point of contact for escalation of provider disputes or sensitive situations that staff was unable to resolve. Monitor and maintenance/reporting of department metrics. Develop and write team policies to ensure consistency of processes for offices in 2 states.

Responsibilities included management of Quality Assurance and Repricing staff. Monitoring department workflow to ensure company standards for claims processing turnaround were maintained as well as maintenance and reporting of department metrics. Hiring, training, mentoring and reviewing of staff. Setting and monitoring QA criteria to ensure company policy of 98% review and accuracy standards were maintained. UAT for all system enhancements or changes that impacted claims repricing including provider demographic UAT. Testing and results reporting for all new EDI claims exchange clients. Development and maintenance of all department policy literature and staff repricing manuals.