rxclaims project coordinator certified medical coder resume example

• Collaborated with relevant parties to resolve billing issues, insurance claims and patient payments.
• Reviewed claims for coding accuracy.
• Coordinated communications between patients, billing personnel and insurance carriers.
• Reviewed account information to confirm patient and insurance information is accurate and complete.
• Track incoming requests for Medicaid PID updates.
• Uses the Government Payer Website to investigate Medicaid drug coverage.
• Records and escalates Urgent incoming Medicaid requests and Emergency Medical Requests (EMR’s).
• Examines claims and calculates reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation.
• Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports, and payment posting.
• Direct claims to and coordinate and support specialty units.
• Comply with federal and state laws, company policies and procedures for Medicaid requests.

• Completed data entry to facilitate case interview and elicited close contacts into designated system immediately after obtaining.
• Followed set protocol for contacting assigned newly diagnosed COVID-19 case patients and documented contact attempts and timeframes.
• Explained importance of contact tracing to prevent disease transmission and keep communities healthy.
• Leveraged scripted template to guide interview process, ask required questions and conduct interactions with professionalism and empathy.
• Furnished case patients with contact information outlined in Connecticut protocol for local health department to support contact tracing.
• Educated clients on options to assist in making informed decisions.
• Advised on policy development and assisted in community program implementation.
• Provided information to access financial assistance, legal aid or housing.
• Helped people enroll in programs, arrange transportation and coordinate paperwork.

· Identifies trends and analyzes payment posting and adjustment data

· Audits adjustment postings to ensure compliance with existing policies and procedures

· Research and resolve accounting reconciling items

· Communicates with teams internal and external to the Finance organization and assist management of process improvements

· Provides feedback/recommendations to the business on enhancements to existing processes

· Utilizes Service Level Agreement tracking to create monthly metrics for upper management to review to ensure Service Level Agreements conformance.

· Identifies areas of user experience improvement opportunities in newly developed and implemented processes.

· Provide metrics related to the centralized mail box to Business leads for performance reconciliation

· Manages customer service, scope and assess processes with internal matrix partners and vendors

· Ensures smooth implementation of CPM initiatives through proper tracking and clear communication

· Provides feedback to business partners on common issues and areas for improvement opportunities in relation to the submission of work requests