Christopher Pawlowski

Depending on the specific contracted services an associate may perform one or more of the following activities:
Inbound Phone Queue/General Program Inquires.
Determination for support programs (Copay, Patient Assistance Program, Medicaid, etc.).
Pharmacy triage and coordination.
Order processing for wholesale orders.
Other follow-up activities (missing info, prior authorization, etc.).
Intakes and reports adverse events as directed.
Researches and resolves any claim denials or underpayment of claims.
Effectively utilizes various means for collecting information using program approved methods, which could include phone, fax, mail, and online methods.
Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
Reports any trends or delays to program management (e.g. billing denials, claim denials, pricing errors, payments, etc.).
Ensures all program correspondence and communication (phone, fax, mail, etc.) meets quality standards.
Works with patient, provider or internal shared services to ensure all necessary documentation is received and complete in accordance with program policy.
Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required.

Performs related duties as assigned.

• Maintained patient confidentiality by adhering to HIPAA regulations and diligently updating records as needed.
• Resolved patient complaints promptly, demonstrating empathy and understanding while seeking mutually beneficial solutions.
• Managed high call volume, prioritizing urgent issues and directing calls appropriately for optimal resolution.
• Provided exceptional customer service to build strong relationships with patients, leading to increased loyalty and return visits.
• Implemented effective time management strategies that allowed me to balance multiple responsibilities, resulting in improved productivity and patient satisfaction.
• Compiled and maintained patient medical records to keep information complete and up-to-date.

Daily responsibilities included but were not limited to: Daily interactions with doctors offices, hospitals & patients.  Responsible for obtaining medical records, office notes & prior authorizations for primary & secondary insurance billing.  Appealing & overturning insurance denials. Cash posting 10-15K daily. Charge entry, ECS & credit card billing.  Insurance verification when needed. Created SOPS for company use for new employees. Took part in problem solving meetings with management. Closely managed monthly reconciliation schedules of all assigned accounts. Reviewed collection reports to determine the status of collections and the amounts of outstanding balances. Collected and arranged information and entered details into computer database.

Responsible for various functions in the Healthcare Billing Department Researching patient accounts, resolving denials, rebilling claims. Making cash posting adjustments. Collection of account receivables while also working reimbursement-related projects. Understand key tasks within Billing, Collections, Cash Posting, and Insurance Eligibility. Effectively utilize Microsoft Excel and other system tools to maximize efficiency .Maintain productivity standards set by management

Correcting/Resolving billing errors, resubmission/and or follow-up of insurance claims. Assessing patients for financial assistance, handling of bad debt accounts, discuss and set up payment arrangements with patients. Following up and resolving rejected claims. Day to day correspondence with various patients and insurance companies. Handling reimbursement of patient and insurance over payment. Explaining the purpose of EOB's to patients for secondary insurance payments.

Updating patient personal and insurance information, submitting claims to various insurance companies and credit card billing. Trouble shooting accounts. Analyzing and breaking down bad debt at its origin. Formulating and implementing plans that will resolve any issues that can be considered a weakness in the billing process, which can range anywhere from the patient to the insurance company. Obtaining necessary data from physicians, hospitals, and patients, to insure proper billing. Copied, logged and scanned supporting documentation. Verified data integrity and accuracy.