Cozie Young

• Accurately processing inpatient and outpatient claims to all payers, including government and commercial payers
• Interpreting payer contracts and processing contractual adjustments
• Review medical charts to ensure completeness, accuracy, and compliance with guidelines and regulations for claims billing or adjudication
• Work with Management in developing streamlined process for claims management to increase volume and profitability
• Assist team with backlog and special projects to meet company metrics
• Compile financial analysis monthly for generated revenue and account tracking
• Verified accuracy of accounts payable payments, resulting in 80% reduction in payment errors and check reissues.
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
• Ensured timely payments from insurance providers through submission of accurate and complete claims.
• Reduced claim denials by meticulously reviewing patient insurance information and coding practices.

Responsible for billing, follow-up, and resolution of medical claims, contributing to team revenue goals, averaging40-50 complex claims daily

• Negotiate TPL and attorney settlements for account resolution
• Coordinate training and assist with QA for team members, ensuring met or exceed performance metrics
• Review EOBs to ensure correct posting allowances, adjustments, and payments
• Conducted payment research and appeals for claim adjudication
• Gathered pertinent patient information over the phone or in person for high dollar medical claims adjudication

• Advanced knowledge of claims process and billed claims accordingly to Medicare, Medicaid, and third-party providers
• Proficient with web portals like Availity, client systems, and databases as necessary to document and resolve medical claims
• Accurately process Remittance/Explanation of Benefits to accounts and process secondary billing to correct payers or patient
• Directed claims negotiations within allowable limit of $20,000 and supported successful litigations for advanced issues.

• Triage, investigate and bill auto accident medical claims for facilities and physicians
• Follow up to verify claim status and resolve submission issues and resubmit or appeal claim for resolution
• Met or exceeded monthly metric goals working through work ques or claim ownership
• Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
• Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
• Developed strong relationships with clients, facilitating trust and open communication during claims process.