AMBER DELOZA

Build and load custom fee schedules for Dental, Medical, Behavioral Health, and Medicare using programs such as Rate Management System (RMS), Centralized Batch Processing Application (CBPA), and other Rate building tools.

• Followed all company policies and procedures to deliver quality work.

• Responsible for reviewing Provider contracting submissions for completion.
• Maintain and update provider demographic and contract information in appropriate systems to support claims adjudication and provider directories.
• Working closely with Recruiters and Liaisons to obtain any missing or additional information.
• Sending providers for credentialing and adding them to EPDB and SCM once they pass. Perform maintenance on existing provider files as needed or requested.
• Managing work through Quickbase and uploading necessary documents into AIRS.

• National claims processor for all dental products offered and administered by Aetna, Inc
• Traditional, Deductible, Medicare, Tricare Benefit specialist: consulting with dental offices (D.D.S and back-office staff)
• High level consultation with staff to ensure proper service coding and benefits application
• Customer Service duties with Aetna direct consumer clients
• Advising the Aetna consumer with understanding benefits and services allowed within and outside of contracted networks specific to each plan.

• Dental claims processing and Oral surgery Dental Industry Number (DIN) coding Handling Dental Medical Integration (DMI) claims processing Applying an expanded understanding of medical and dental claims processing Consult with claims adjudication and billing review.

• Dental claims processing Processing claims, dental service coding and cost share coding Consult with claims adjudication and billing review.

• Manage office coordination: maintaining and coordinating the link between Director and the office
• Creating and maintaining office documents: office documents such as, invoices, reports, data sheets
• Maintain the inflow and outflow of supplies, arrange for repair and maintenance of office equipment, receive, store and maintain inventory of office supplies and equipment, and send, receive and sort mail and other packages
• Arranging meetings and other gatherings