Denise Foster-Tutt

• Understand, and assure compliance to and adherence with, Medicaid and Medicare enrollment regulations and related CCA policies and procedures
• Meticulously and accurately execute all reconciliation activities, with a high level of quality and proactively identifying inaccuracies in data of all types
• Transfer/Download files from Medicare, Medicaid and other data sources as needed
• Review enrollment data reports from Medicare, Medicaid, and CCA contracted vendors to confirm enrollment history
• Investigate enrollment data discrepancies, using various internal and external systems to identify the correct information and resolve discrepancies
• Gather supporting documentation and submit appeals to Medicaid and or Medicare as appropriate
• Review, verify and follow up on appeals submitted to Medicaid and Medicare ensure accurate eligibility updates and premium payment has been received
• Perform book of business reconciliation for CCA contracted vendors
• Work with identified staff to resolve discrepancies, to identify trends and escalate as needed
• Research Prescription Drug Event (PDE) errors to identify and correct information; work with the Pharmacy Benefit Manager (PBM) as needed
• Identify and track cases requiring payments to and from other plans in accordance to the Medicare's Plan to Plan process
• Offer recommendations for improvements in CCA and departmental practices to improve workflows and procedures
• Research and respond to information requests from Medicare, Medicaid and CCA contracted vendors
• Complete productivity and status reports according to the established timeframes

• Provides assistance to indigent patients in completing and submitting paperwork for MassHealth, creates agreements with patients that are not financially able to pay off account in full
• Provides benefit education to patients, parents and guarantors, effectively communicates insurance, claims or patient's self-pay responsibilities to patient, determines accurate third party and self-pay liability, requests upfront collections of self-pay deposits from patients both inpatient and outpatient
• Accurately prepares cash deposits daily and submits them timely to AP for cash posting
• Prioritizes follow-up on self-pay accounts as appropriate, but no less than every 30 days.

• Review and process referral request and obtain all insurance authorization
• Receives inbound contacts (calls, emails, faxes, etc.) from patients, physicians and vendors requesting services within/out Atrius Health
• Coordinates complex appointment scheduling, linking referrals and ancillary services required for assigned specialty services within/out the organization
• Maintain patient demographic and insurance pre-registration information in appropriate department scheduling system(s) (EPIC)
• Answer patients or physicians questions and provide patients with information on physicians, directions to locations and educational materials
• Interviews callers to obtain full understanding of what information is being requested by providing a positive experience to all customers to enhance the overall engagement with the patient

• Educates patient and family members on various medical/health programs and the importance of utilizing them
• Determines eligibility, assists in completions of appropriate applications and serve as a patient advocate
• Work in close collaborations with patients and client hospitals to identify potential qualifying events to further enroll the patient in the appropriate health coverage program
• Provides linkage with appropriate community and government resources

● Responsible for data entry of all providers and member’s information.
● Manage daily membership downloads from Division of Medical Assistance (DMA).
● Process out of network request and perform daily audits of membership and PCP assignments from DMA.
● Research end of monthly member discrepancy report, assist with data quality review of bi-annually provider directory.
● Resolve member eligibility issues from Customer Service, Claims and Medical Management Departments, and process Notice of Birth (NOB).