duties were to follow-up on unpaid claims and appeal denied/underpaid claims. Duties were to appeal denied or underpaid claims within the appeal deadline.

duties were to calculate the reimbursement amount due, per the contract. Duties were to appeal denied or underpaid claims from Managed Care, Commercial, Work Comp and Managed Medicaid accounts by using the contract wording for reimbursement. These accounts usually required research.

duties were to call the insurance companies regarding underpaid accounts and have them reprocess or submit an appeal disputing denial.

duties are to work directly with provider reps at insurance companies for underpaid and/or disputed accounts. I submit a monthly report with underpaid accounts for the insurance company to make adjustments or to explain why account wasn't paid per the contract. I provide any additional information for high dollar accounts or forward them to the appropriate department. Contract interpretation ability.

duties were to appeal denied Medicaid claims, research accounts to determine appropriate action for payment. I also determine if claims have been paid correctly or incorrectly.

duties were to check claims status for three Medicaid Managed Care plans (Access, Texas Health Network and Amerihealth First), work very close with insurance companies to resolve issues and appeal accounts when denials aren't justified. Supervised two employees. I did whatever it took to get the claims paid.

duties were to check claims status for Medicaid claims with a balance and/or under paid. I researched claims with denials and take appropriate action to correct, re-file, and/or appeal unpaid claims, along with sending appropriate documentation for payment processing.

Bachelor of Science in Business Management - Date of Completion is 5/2009

Human Services Degree & LCDC Certificate