Reviewing data claims for the purpose of overpayment analysis regarding but not limited to areas of duplicate payments, coordination of benefits, billing errors and contractual overpayments.Responsibilities also include researching within the clients system for areas of concern and areas of potential overpayments, or faulty billing practices.Internal teams testing new concepts, tracking and documenting test results to validate the implementation of new edits of data to produce approved concepts for production.Additional testing on new client implementations and special projects to ensure the maximum potential of system searches.As a Validation Liaison, I have a team of 5-10 employees for multiple clients, being the point of contact, for additional information and assistance to meet and exceed the client goals set forth on a monthly/yearly basis, some located within our home office and several which are in other locations.Development of materials and implementation of training of employees on various client processing systems.Supplying them with new hire and additional training when necessary and support through web-conferencing, screen sharing capabilities, and various other forms of communication.Interact with the external clients on a weekly basis for informative approval and clarification of concepts.Consistently achieving and exceeding personal monthly goals set per client, both in productivity and quality, while also working as a team to achieve a monthly team goal. | Experience as a medical claims and life claims auditor, processing calculating and entering data according to individual policy provisions.Evaluate and respond to customer's written and telephone inquiries, incoming mail, electronic claims and agent inquiries, which resulted in the payment, denial, or referral of the claim.Processing of claim refunds and/or overpayments and adjustments to claims.Communicated between the client and the provider of services for completion |
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