Vanessa Lomeli Email and Phone Number

Provider Service/Credentialing

• Run specified overpayment reports on a daily, weekly or monthly basis from report manager (ex: duplicate, timely filling,OIC)• Research, Audit and Initiate overpayment notifications to Providers. • Identify potential recovery opportunities and/or contract issues for individual providers and process overpayments working with the configuration department and/or IT Department. • Effectively address any issues or concerns towards increasing or promoting efficient operations.• Research, Audit and post all incoming refunds into X-press and or EZ-Cap system• Retrieve retractions for check runs with Claims and Finance Department.• Retrieve voicemails and answer phone calls regarding Recovery Overpayments and or credit retractions issues. • Communicate through proper verbal and written channels with all departments.• Communicate to providers regarding guidelines and the reason of the refund request. • Conduct Special Projects as assign• Cash Posting• Reviews written dispute requests received from providers of denied or incorrect payments based on contractual arrangements with providers and non-contractual providers. Regarding either Professional or Institutional Claims• Responsible for requesting special check run requests to insure compliance

•Responsible for accurately entering provider demographics and contract affiliation information into the system. •Receive information from outside party for update of information in computer system(s). •Analyze by applying knowledge and experience to ensure appropriate information has been provided. •Load and maintain provider information into computer system(s) with attention to detail and accuracy in a timely manner to meet department standards of turnaround time and quality.•Audit loaded provider records for quality and financial accuracy and provide documented feedback.•Accurately interpret request entered into the system to ensure all data is correct and claims adjudication is optimized•Encounters