DEGWANDA W FURTICK
Aynor,SC
Summary
Organized, result-driven Medicaid professional with over 22 years of experience. Analyze Medicaid and CHIP claims for accuracy. Works quickly with insurance companies to resolve problematic disputes, performing difficult multitasking and claims-processing tasks while handling patient inquiries. Brings a can-do attitude to collaborating with medical professionals, insurance providers, and clients to handle invoicing within a high-traffic office environment
Professional Medicaid reviewer with high standard for quality and results. Reviewed diverse content, providing precise and valuable feedback to enhance overall quality. Known for strong team collaboration and adaptability to changing needs. Proficient in critical analysis and clear communication.
Overview
27
27
years of professional experience
Work History
Medicaid Reviewer
Empower.Al
11.2021 - Current
- Initiate, support, monitor, and evaluate Medicaid review activities related to PERM (Payment Error Rate Measurement) CMS program integrity task order, including compliance with contract deliverables, internal and external performance requirements
- Knowledge of medical terminology and experience in analyzing and processing Medicaid and CHIP claims in different states' claims processing systems
- Monitor Claim Payment Systems for both Medicaid and Chip and notify management of potential problems/errors and of potential areas for improvement
- Enter final claim decisions into Empower Al's system
- Research different states' MMIS systems as well as policies and procedures in preparation for new PERM review cycle
Site Manager
Partnership Property Management
10.2020 - 11.2021
- Handle resident complaints and expedite maintenance requests
- Inspect properties regularly to identify deficiencies and schedule repairs
- Collect monthly assessments, rental fees, deposits, and payments
- Updated tenant and unit information to keep current in the housing database
- Solicit and analyze bids for repairs, renovation, and general maintenance
- Review completed applications and assessed household information against file history and regulations for 100s of tenants
- Maintain thorough, accurate, and compliant records for internal and regulatory audits
- Conduct apartment tours for potential tenants and answer questions about the property
Lead Customer Service Advocate
Blue Cross Blue Shield Of SC
10.1997 - 05.2020
- Answered customers' questions and addressed complaints by phone fast, friendly, and knowledgeable to immediately rectify issues for more than 100 callers
- Trained new employees on company customer service policies and service level standards
- Utilized active listening skills
- Assisted my team with handling calls and took over escalated concerns to deliver expert solutions
- Coached, monitored, and motivated new employees to boost performance and enhance job knowledge
- Met and exceeded performance goals to support long-term company growth
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments, and remaining balances not covered under their policy
- Completed appeals, filed and submitted claims
- Posted and adjusted payments from insurance companies
- Maintained correct working knowledge of CPT, HCPS, and ICD-10-CM coding principles, government regulations, protocols, and third-party billing requirements
- Submitted refund requests for claims paid in error
- Entered procedure codes, diagnosis codes, and patient information into the system
- Utilized internet and intranet sources for policy verification
- Accurately coded and prepared billing statements for patients and enforced regulations by reviewing federal and state laws to confirm compliance
Education
Associate of Science - Human Services
Horry Georgetown Technical College
Conway, SC12.2013
Skills
- Medical and insurance claims review
- Files and records management
- CPT coding
- CPT code modifiers
- HCPCS coding
- ICD-10-CM coding
- Medicaid claims review
- CHIP claims review
- AdvancedMed System
- CMS timeliness and requirements
- Bill payment and collections
- Facility management
- Microsoft Office Suite
- OSHA safety requirements
- Building cost identification
- Medicare
- Medicaid
- Attention to detail
- Team collaboration
- Audit reporting
- Decision-making
Websites
Timeline
Medicaid Reviewer
Empower.Al
11.2021 - Current
Site Manager
Partnership Property Management
10.2020 - 11.2021
Lead Customer Service Advocate
Blue Cross Blue Shield Of SC
10.1997 - 05.2020
Associate of Science - Human Services
Horry Georgetown Technical College
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