ANDREA S. PHILLIPS

• Evaluate patient account credit balances and performed necessary refund, adjustment, or correction entries.
• Utilize EPIC to enter and track refund transactions to maintain real-time account accuracy and compliance with hospital and regulatory standards. Ensure accuracy in refunds, adjustments and correction entries.
• Apply insurance policy guidelines to ensure accurate refund transactions and account reallocations.
• Assist with coordination of benefits and resolved discrepancies with insurance providers.
• Respond to inquiries from patients, insurance entities, and representatives regarding refund status.
• Perform additional assignments as required to support team and organizational goals.

• Manage appropriate adjudication of claims in accordance with policy provisions.
• Managed a diverse caseload of insurance claims, ensuring accuracy, timeliness, and compliance with industry regulations.
• Review claims for compliance with plan guidelines and approve or deny payment.
• Document claims adjudication decisions clearly and concisely. Maintain timely responses to appeals and reconsideration requests.

• Perform internal audits on Medicaid and Medicare calls.
• Provide feedback and coaching regarding proper documentation /recordkeeping best practices and auditing practices.
• Establish auditing goals, expectations and ensure these are met or exceeded.
• Complete departmental and individual training and professional development.
• Track trends and audit results

• Assisted providers and Medicaid members regarding benefits and account inquires.
• Respond to and resolve customer inquiries on first call.
• Assist customers with inquiries, benefits, claims and eligibility.
• Assist member's with scheduling appointments for members and choosing doctors.

Make inbound calls, collect outstanding balances, educate customer about negative balance, collect debit/credit card payments, EFT/draft payments, Answer inbound calls, accept payments. Operate multiple systems during each calls, meet monthly quotas.

Answer inbound calls, process insurance applications, educate the consumer about insurance plans, enroll consumers in insurance plans. Operate multiple systems.