Reimbursement Specialist (contractor) Resume Scottsdale AZ - Hire IT People

SUMMARY:

Professional experience working with private and public insurance plans, pharmacy claims adjudication, call center Inbound/Outbound bilingual customer service, with previous working experience with bodily injury, general liability claims and safety management. Passionate and consistent in achieving success in all endeavors while using exemplary verbal, written and inter - personal communication skills.
Computer skills with Microsoft Excel, Word, Outlook
Electronic Data Information Systems, Sales Force & MedForce Claims System

PROFESSIONAL EXPERIENCE:

Confidential - Scottsdale AZ

Reimbursement Specialist (contractor)

Responsibilities:

Perform 23-35 case reimbursement investigations per day at a 96% accuracy rate or better by following HIPPA and PHI mandated regulations, utilized Sales Force to contact commercial insurance payers for clients with HMO, PPO, POS, Medicaid and Medicare A & B coverage to verify Confidential t eligibility for product specific coverage information for reimbursement. Update all information into Sales Force case management system and forward findings to case manager for further processing.
Provide accurate and timely follow-up to all reimbursement inquiries from case managers, providers and Confidential ts in accordance to program guidelines. Provide prior authorization assistance to physicians and/or case management office staff. Interface with physicians, advocates, Confidential ts and manufacturer representatives regarding payer policy and reimbursement.
Utilized Word, Outlook, Sales Force and internet services to research and compile payer specific information for reimbursement database.

Confidential - Phoenix AZ

Auditor/Claims Processor (contractor)

Responsibilities:

Perform claim audits for quality assurance to achieve a minimum of 98% accuracy of Medicare Part D and commercial claims processed by in-house claims processors. Responsibilities included review of data, documentation and HIPPA, PHI and program guidelines, adjudicate the claim and approve for reimbursement.
Processed Medicare Part D and Commercial prescription claims using internal systems and controls according to Confidential guidelines. Responsibilities included reviewing of all documentation provided and following program guidelines.
Utilized Word, Excel, Outlook, provided reports to supervisor for trends and claim count.

Confidential - Scottsdale AZ

Processor (contractor)

Responsibilities:

Following HIPPA and PHI government regulations, responsibilities included pre-preprocessing customer commercial drug prescription claims through MedForce that included insurance companies such as Aetna, BCBS and Medicare Part D.
Perform pre-processing screening at a 100% accuracy that included: scanning of documents into MedForce, data entry, preparing claims for processors by researching insurance policies, verifying eligibility and assign claims to processors.
Other duties included: processing of company mail and distribution thereof, and processing of manual reject Letters through an Access database and mailing letters to customers.

Confidential - Phoenix AZ

Enrollment Specialist (contractor)

Responsibilities:

Inbound/Outbound call center presenting dental program to parents through a scripted campaign, obtain all student enrollment information over a recorded line, enter and/or update enrollment information into RHA database, research coverage information for eligibility and last date of service and complete permission requirements per company, state and federal laws.
Perform processed applications at a 100% accuracy rate. Process completed and incomplete enrollment forms sent in through the school nurse, data entry of all information received and distribute enrollment according to state and school for customer care associates. Research and/or and contact parent to complete uncompleted enrollment forms received and set appointments.

Confidential - Phoenix AZ

Collection & Recovery Specialist

Responsibilities:

Inbound/Outbound collections call center providing collections/recovery services on overdue accounts for our clients.
Contacting both English & Spanish speaking customers by telephone and/or correspondence to collect on past due accounts for auto rental charges, damages or rental charge backs using skip tracing tools and documenting all communication with the customer into our customer account database.
Negotiated payments, offer account resolutions terms, accept or deny settlements and receive customer payments over the phone and upload into their account.
Subrogate third party claims for auto property claims for insurance reimbursement.