Fifteen years in Government Programs with Palmetto GBA; highly organized and detail-orientated; able to prioritize and complete multiple tasks to achieve project goals; strong interpersonal skills that work effectively in a highly interactive team environment; expertise in interpreting Medicare rules and guidelines as outlined by The Centers for Medicare & Medicaid Services (CMS); HCPCS coding; ICD-9 coding; an understanding of medical terminology, appeal guidelines and overpayment procedures; proficient in technical, leadership and management skills.
Microsoft Office 2010: Word, Excel, PowerPoint, Access, Visio, Project, Publisher
*Higlas, FISS, NGD
Sr. Project Assistant October 2009 to CurrentPalmetto GBA － SC
Assign action items, including provider call-backs, provider inquiries and overpayment recalculations, daily to all team members as required, maintain database, and review final documents, to include letters, ARs and spread sheets, for quality control.
Answer complex provider and attorney telephone and written inquiries concerning payments, offsets, recoupments, refunds and appeal statuses timely.
Point of contact for Part A inquiries from the Finance & Accounting area and the Provider Contact Center (PCC).
Liaison between the provider community and area Program Safeguard Contractor (PSC).
Responsible for processing PSC overpayment requests to include initial AR set-up, appeal status updates and multi-million dollar overpayment recalculations.
Compile and maintain monthly reports for open PSC overpayments to include original amounts, accrued interest charges, payments, current balances and appeal statuses.
Submit monthly reports to management, each PSC and CMS timely.
Coordinate special projects as requested by management.
Coverage Policy Specialist August 2008 to October 2009
Wrote, reviewed, edited and delivered training materials for the Provider Contact Center (PCC) staff to include policy and procedure changes and Medicare updates.
Edited and proofed monthly publications and external training deliverables for the provider community.
Wrote news articles and updates for publication on the J1 A/B MAC Web site.
Participated in various weekly and monthly conference calls and meetings between management, training department, medical staff, and other departments related to upcoming training events and CMS contract requirements as well as other updates and changes.
Updated and published IVR job aids for the provider community, as required by CMS.
Co-led the Data Analysis Workgroup which focused on training needs for PCC staff and included compiling, interpreting and maintaining necessary reports.
Instructional Writer June 2007 to August 2008
Reviewed and edited all training materials, including lesson plans and hardcopy modules.
Proofed tests and e-learning products prior to submission to CMS or other customers.
Made changes to content to enhance final product prior to delivery.
Wrote reports that documented PLD 2 team activity and performance.
Submitted weekly and monthly reports to CMS timely.
Monitored deliverable deadlines against project plan.
Participated in writing training materials for weekly Refresher Trainings.
Participated in numerous weekly conference calls with CMS and external customers related to written training materials.
Served as co-lead for written correspondence training materials.
Highly skilled with Next Generation Desktop (NGD) software and wrote training materials for NGD users.
Responded to action items assigned by manager.
Team Member Associate II May 2000 to June 2007
Wrote letters to beneficiaries and providers in response to inquiries and appeal requests.
Provided written education to beneficiary and provider audience at Medicare and DMERC.
Wrote ISO desk procedures, job aids, and other instructional materials.
Processed hard copy and electronic DMEPOS claims which included reviewing claims and medical certification data.
Keyed claims and certification data into computer system and resolved edits for suspended claims.
Conducted extensive, thorough research and responded to inquiries received from physicians, suppliers and beneficiaries in a timely fashion and adjusted claims as necessary.
Effectively recognized potential fraud/abuse situations and referred to the appropriate DMERC unit.
Processed Medicare appeals that requested re-examination of previously processed claims.
Reviewed claims for eligibility and determined if requirements were met or if utilization levels were exceeded.
Answered a high volume of calls from providers of DMEPOS items concerning claim status, resolution and education.
Served as founding member of the Correspondence Workgroup and actively participated in monthly activities.
Interacted with various departments to streamline and work out processes between them.
Handled solicited/unsolicited check resolution and overpayment case research.
Interpreted workload reports and coordinated with the team in daily decision making relative to work assignment, scheduling, overtime needs, etc., as necessary.
Assisted with researching quality errors, provided remedial education to new team members and attended meetings as appropriate.
Assisted with interviewing prospective team members and provided on the job training.
Provided input into preparing and managing the team budget and the ongoing performance review process.
Made recommendations to enhance system parameters and daily workload procedures.
Participated in testing and implementation for new software releases.
Participated in process improvements.
Wrote Quality Work Instructions in compliance with ISO certification.
Bachelor of Science : Business Administration, PresentSouth UniversityGPA: GPA: 3.79Business Administration GPA: 3.79
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Bachelor of Science : Business Administration , Present
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