Wendy Richerson Email & Phone Number

Manteno, Il, Us

Manteno, Il, Us

Dallas, Texas, Us

Temple, Texas, Us

Working with EDI encounters to the state of Texas. EDIFECS experience in working with rejected encounters. Working with other departments to get rejected encounters corrected, resent and prevent future rejects.

Us

Improve processes for the State of Texas Medicaid and supervise others in processing and resubmitting errors to the state. Collaborate with multiple departments to ensure claims were resubmitted quickly. Direct the daily operations for compliance, state inquiries, and reporting. Key Accomplishment:• Manage the compliance process to guide clients from noncompliant to compliant.

Phoenix, Az, Us

Successfully managed the transition from Bridgegate to Accelehealth. Implemented reporting statistics on inbound eligibility files and communicated with clients regarding turnaround time. Created workflows and schedules. Acted as a liaison and production support for Accelehealth. Key Accomplishment:• Spearheaded the conversion from an old system to a new one by building and maintaining templates for 834 inbound files.

Us

Oversaw all aspects of the claim paying system by working with code lists and provider matching and building benefit plans to include Medical, HMO, High Deductible plans, Medicaid, and PPO plans. Reviewed the plan documents as needed. Ensured full HIPPA compliance. Acted as subject matter expert for troubleshooting Accelehealth and for upgrades and conversions of the system. Performed 5010/X12/TR3 readiness planning, testing, and implementation. Key Accomplishment:• Developed processes and procedures for the set-up, testing, and implementation of Accelehealth.

Oak Brook, Il, Us

• Responsible for the start-up and completion of the auto adjudication program involving the proper assignment of medical and dental diagnosis codes, CPT/HCPCS, place of service and revenue codes. Worked one-on-one with claims examiners to execute the maximum auto adjudication as possible with little to no intervention.• Worked closely with the training departments to help develop procedures and processes for the current claim payment software.• Built plan abstracts based on the thorough review of clients plan documents. Converted new clients and existing clients plan documents to current standards and compliance with regulations in the insurance industry.• Close contact with software vendor calling in problem logs and executing upgrades to the system.• Implemented the EDI HIIPAA compliant 837 I and P claim loads/dumps with vendors.• Worked with PPO contracts and vendors including set up and maintaining provider records and PPO’s.• Issued/re-issued 1099’s and W-2’s for clients.• Manager/Supervisor of multiple departments including provider maintenance, plan building and data entry.• Successfully mentored others in areas such as plan building, plan payment, benefit coding and auto adjudication.• Testing of all pertinent upgrades prior to implementing to production.• Audited medical, dental and vision claims to insure correct claim payments based on plan documents and internal guidelines.