CATINA HAY

• Resolved escalated claims within Epic Work Queues related to both in-house and outsourced claims
• Identified payer trends for Workers' Compensation and PIP claims, driving process improvement and reduced aged Accounts Receivable
• Trained new hires and existing staff on claims processes, procedures, and system navigation, fostering team development and efficiency
• Developed and implemented SOPs and training materials, including tip sheets, to streamline workflows and enhance team performance
• Facilitated regular meetings to address payer issues, answer questions, and promote cross-functional collaboration
• Close collaboration with supervisory and legal teams
• Managed daily distribution of team voicemails and faxes, ensuring prompt response and issue resolution
• Approved write-offs and analyzed over $10K report, identifying accounts requiring leadership or legal intervention for resolution
• Coordinated with offshore vendors, communicating process issues and ensuring adherence to performance expectations
• Reviewed and resolved issues submitted to 'Question and Answer' spreadsheet

• Reviewed and corrected patient demographic, identification, and insurance information via EPIC
• Recovered payment via various contact methods for workers' compensation and motor vehicle insurers.
• Processed refunds to be completed by the credit department.
• Mentored new hires.
• Reallocated incorrectly posted funds
• Worked with various departments to ensure claim correction and proper reimbursement.
• Completed special projects assigned by the direct manager.
• Processed assigned correspondence, voicemails, faxes, and emails.

• Processed correspondence, voicemails, faxes, and emails
• Completed special projects assigned by direct Manager
• Completed record and voicemail distribution to team
• Performed adjustments and processed refunds to be completed by credit department
• Reallocated incorrectly posted funds
• Reviewed and corrected patient demographics, identification, and insurance information initially using Meditech, then switching to Epic and Huron systems
• Recovered payments via phone, email, fax, and mail contact with various Workers Compensation and Motor Vehicle insurers

• Researched patient demographics, medical history, vital information, and medical records using Meditech system
• Ensured patients' insurance information was current
• Submitted bills using Pro 32, Masshealth and POS systems, as well as using FISS and MMIS for payment of Medicare and Masshealth/Medicaid claims
• Created billing files and storage in office filing system
• Performed data entry in relation to payments
• Logged Psychiatry weekly visit logs along with Dialysis, Emergency, MRI, and Dental visits
• Followed up on collection of aging claims via aging reports

• Researched claims that are rejected due to different issues such as coding, and patient eligibility
• Direct point of contact for commercial insurance provider services representatives, workers compensation, as well as motor vehicle accident claims contact for attorneys
• Located, certified, and forwarded patient account information requested by attorneys and insurance carriers
• Corrected coding issues, patient demographic information, insurance information and file claims
• Covered for patient payment representative and self-pay collection representative when not in office
• Corrected payment discrepancies
• Utilized both CPS, MMIS systems, and utilize insurance company websites for research purposes
• Participated in weekly meetings with supervisor and manager to determine best practices

• Performed duties related to both positions
• Investigated and resolved high profile and complex claim appeals for increased reimbursement
• Researched facility contracts to ensure payer compliance and was single point of contact for New York state hospitals
• Researched fee schedule issues and assisted with long term solutions
• Facilitated claim adjustments with clients including claim adjudication and reviewed/audited claims and client payments ensuring payment accuracy, and responded to client inquiries regarding proper interpretation of contracts
• Produced reports for high profile facilities
• Maintained continuous communication with facilities until issue resolved, including conference calls
• Worked closely with other units to identify root cause for both ancillary and facility claims issues
• Entered HCFA/CMS and UB data into system and reviewed electronic filing database (EDI)
• Assisted in training, and worked with supervisors to improve workflows and procedures.
• Triaged claim disputes submitted by PPO network providers
• Resolved facility claim issues through thorough research and contact with insurers
• Maintained records of claim reviews and claim information
• Entered information into company tracking software for future review
• Responded to inquiries by providers and clients in relation to claim reviews, fee and contract information
• Mentored new hires; assisted in transitioning from training to full duties
• Point of reference for assistance with difficult claim issues

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• Received calls from insurance members, representative, and network providers
• Triage calls to determine caller's issue
• Answered question relating to status, requirements for participation and claims related questions
• Ordered applications using the Allied software system
• Routed claims issues to appropriate claims teams for resolution