Annette Williams

• Processed STAR/Medicaid and Children's Health Insurance Program (CHIP) claims.
• Ensured appeals were processed according to claims processing guidelines and contracts.
• Reviewed and processed pended claims within 5 days of initial review.
• Reviewed, researched, and applied provider refunds in a timely manner.
• Processed refunds/retractions identified by TCHP contracted vendors within a 30 day turn around.
• Tested claims for functionality, accuracy, benefit payment, contract interpretation, and compliance with policy and procedures. Identified errors utilizing our testing environment to ensure a prompt resolution.
• Identified trends related to appeals and claims processing.
• Extensive knowledge of ICD-9, ICD-10, and CPT codes, coordination of benefits, HIPPA regulations, and medical terminology.

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• Position involves processing medical, dental, and vision claims for multiple Medicare Advantra replacement plans, processing high dollar claims, identifying and reporting possible claim overpayments, underpayments, and any other irregularities, making necessary outbound calls to obtain required information for initial claim reconsiderations, performing claim re-work calculations, verifying eligibility, and ensuring all compliance requirements were satisfied and all payments were made in accordance with company policy and procedures
• Extensive knowledge of ICD-9, ICD-10, and CPT codes, HCFA, UB-92, and UB-40 medical claim forms, coordination of benefits, HIPPA regulations, Medicare, Medicaid, and medical terminology.

• Position involved processing medical, dental, and vision claims for multiple Medicare Advantra replacement plans, processing high dollar claims, identifying and reporting possible claim overpayments, underpayments, and any other irregularities, making necessary outbound calls to obtain required information for initial claim work or reconsideration, performing claim re-work calculations, and ensuring all compliance requirements were satisfied and all payments were made in accordance with company policy and procedures, and trained to support call center activity as required, including general member and/or provider inquiries
• Extensive knowledge of ICD-9, ICD-10, and CPT codes, HCFA, UB-92, and UB-40 medical claim forms, coordination of benefits, HIPPA regulations, Medicare, Medicaid, and medical terminology.

• Position involved processing hospital claims and coordinating them with Medicare benefits
• Extensive knowledge of ICD-9 and CPT codes, HCFA, UB-92, and UB-40 medical claim forms, coordination of benefits, HIPPA regulations, Medicare, Medicaid, and medical terminology.

• Position involved processing medical, dental, prescription, and vision claims for commercial plans, processing high dollar claims, performing claim re-work calculations, and trained to support call center activity as required, including general member and/or provider inquiries
• Extensive knowledge of ICD-9 and CPT codes, HCFA, UB-92, and UB-40 medical claim forms, coordination of benefits, HIPPA regulations, Medicare, Medicaid, and medical terminology.

• Position involved processing medical, dental, prescription, and vision claims for commercial plans, processing high dollar claims, performing claim re-work calculations, and trained to support call center activity as required, including general member and/or provider inquiries
• Extensive knowledge of ICD-9 and CPT codes, HCFA, UB-92, and UB-40 medical claim forms, coordination of benefits, HIPPA regulations, Medicare, Medicaid, and medical terminology.