Barbara Turner

• Analyzes and approves routine claims that cannot be auto adjudicated.
• Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
• Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection
  processes, claim coding, including procedure, diagnosis and pre-coding requirements.
• Utilizes all applicable system functions available ensuring accurate and timely claim processing.

• Provided expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
• Analyzed and identified trends and provide reports as necessary.
• Consistently met established productivity, schedule adherence and quality standards.
• Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.

• Sent correspondence to members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections.
• Responsible for reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes.
• Reconciled eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes.
• Researched errors by comparing enrollment error reports against system information along with CMS (Center for Medicare and Medicaid Services) records.

technical support representative

• Equipment configuration: Configuring complex equipment, such as scientific equipment, telecommunications, or IT systems.Troubleshoot the issue over the phone.