Allison Fischer
LAKELAND
Summary
Detail-oriented Claims Process Specialist with extensive Medicaid and Medicare expertise. Proven ability to manage complex claims and enhance operational efficiency through data analysis and project collaboration.
Overview
27
27
years of professional experience
Work History
Claim Process Specialist/Subject Matter Expert COB
Cognizant Technologies
Tampa, FL
02.2024 - Current
- Make calls to commercial/Medicare Insurance Companies
- Verify members'' eligibility
- Update eligibility in healthcare system
- Update COB notes in healthcare system
- Add other insurance insurance coverage in healthcare system
- Investigate Medicare coverage
- Work on COB projects
- Worked Maestro COB case reviews
Subject Matter Specialist Claims
Cognizant Technologies
Tampa, FL
06.2016 - 02.2024
- Processed hospital and medical claims to ensure timely reimbursement
- adjusted claims
- Resolve SR requests
- Resolved system edits
- Analyze appeals
- Manually priced claims
- Provided training within the department
- Worked on projects
- Supplied guidance to the department as needed
Supervisor of Business Auditors of Quality
Prestige Health Choice
Tampa, FL
03.2015 - 09.2016
- Supervised 7 associates
- Trained new hires
- Reviewed and worked AR reports
- Worked on recovery reports
- Approved timecards
- Worked on special projects
- Attended meetings
- Provided support to the department
Claims Business Analyst
Royal Health Care
Islandia, NY
03.2000 - 08.2011
- Processed readmission claims to ensure accurate reimbursements and compliance with regulations
- Communicated with providers regarding readmission claims
- Requested medical records
- Reviewed and processed high dollar claims
- Analyzed and processed interest payments
- Worked on projects
- Data entry of referrals
- Interacted with clients to resolve any issues
Claim Examiner
Royal Health Care
Islandia, NY
06.1999 - 03.2000
- Reviewed and adjudicated hospital and medical claims for accuracy and compliance with policy guidelines
- Resolved claim edits
- Provided feedback to management regarding payments and system issues
- Worked projects
Education
Associate of Science - Office Automation
Nassau Community College
Garden City, NY05-1994
High School Diploma -
Maine West High School
Des Plaines, IL05-1984
Skills
- Medicaid and Medicare expertise
- UB92 & CMS-1500 Claims
- ICD9/ICD10, Revenue codes, CPT, HCPCS, Medicaid fee schedules, APR DRG pricing
- Data analysis and presentation
- Excel, Word, Genesys Cloud and Outlook, Google
- Facets, Pegasys, Webstrat, Q-Care, DST, Maestro
- HIPAA compliance training
- Facets, Pegasys, Webstrat, Q-Care, DST, Maestro,
- Function in a fast-paced environment
- Excellent organizational skills
- Work independently
- Remote work experience
Timeline
Claim Process Specialist/Subject Matter Expert COB
Cognizant Technologies
02.2024 - Current
Subject Matter Specialist Claims
Cognizant Technologies
06.2016 - 02.2024
Supervisor of Business Auditors of Quality
Prestige Health Choice
03.2015 - 09.2016
Claims Business Analyst
Royal Health Care
03.2000 - 08.2011
Claim Examiner
Royal Health Care
06.1999 - 03.2000
Associate of Science - Office Automation
Nassau Community College
High School Diploma -
Maine West High School