angela phillips

* Collect insurance claim data for review to ensure timely resolution on existing and outstanding issues. * Consistently follow-up with the insurance company to discover the determination and the appeal progress level. * Submit claims appeal/reconsideration letters and medical records to insurance companies to resolve denials. * Audit insurance claims and search for underpayments * Maintain a call log inside the patient electronic file * Keep track of claim and appeal filing deadlines * Knowledge of managed care plans, Medicare, Medicaid policies * Ensure claims paid per fee schedule and provider contract

* Answer 60-100 patient and provider calls * High volume, fast paced call center * Escalated calls and issues * Provider and patient complaints * Completed all online claims and benefits inquiries * Developing company website

* Answer 70-100 patient and provider calls * Behavioral Health benefits verification * Prior authorizations * Highly demanding call center environment

* Overlooking 5 to 10 employees * Performed audit of randomly selected claims to ensure quality processing * Implements training sessions for processing procedural updates * Entered, researched and processed medical claims according to medical plan benefits * Reviewing claims appeal letters and Adjusting claims to ensure corrected payment * Researches claim overpayments and request funds * Made phone calls to confirm the accuracy of medical claims * Entering Provider fee schedules and Members benefits in system for Testing purposes