CORNELIA VENERABLE

• Review medical documentation for accuracy/medical necessity
• Submit for prior authorization with all required documentation to appropriate funding source
• Maintain consistent follow up on status of all prior authorization requests
• Review authorizations from payer to determine approved/denied items
• Calculate estimated copay based on current insurance benefits
• Communicate with Supervisor in regard to issues/changes with Payer
• Respond to all internal and external customers in a timely & professional manner

I was at home with my son.

• Performed light cleaning duties such as dusting, vacuuming, and wiping down bathrooms.
• Completed laundry services with special attention to care instructions for hand-washing and dry cleaning.

• Answering incoming calls from healthcare providers about Medicaid and Medicaid claims
• Educated providers on why claims were denied and assisted with how they can resubmit the claims
• Educated providers on NC Medicaid policies, guidelines, and requirements
• The position is in a call center environment where call volumes fluctuate
• Performance is measured based on combination of quality, timeliness, and availability to the customer
• Acts as initial contact for providers requiring Medicaid claim assistance
• Accurately receive, research, and resolve most provider inquiries
• If an inquiry cannot be resolved at point of contact, tracks the inquiry to completion through the appropriate departments.

• Data entry, report creation/analysis, data reconciliation, limited problem resolution
• Then used the verified information to match revenue to sales for sales reps to receive commission
• Also, used similar reports to match sales to revenue for customers to receive rebates
• Maintained files, data entry daily.

• Investigate status of ambulance claims submitted for payment, Update and verify insurance and billing information
• Update and submit claims to the payer or insurance provider that have been denied payment.