DIANE STETZER

Experience

Legal Administrative Specialist
Reno Nevada

Dept. of Veteran Affairs/ March 10, 2024 to Current

· Work in a remote workspace to answer inbound telephone calls from more than 8 million individual Veteran inquiries per year. National Call Center personnel provide telephone assistance to Veterans, their dependents, and survivors with information, advice and assistance regarding the availability and procurement of benefits under laws administered by the Department of Veterans Affairs (VA) and other agencies.

· Advising and providing information on benefits and rights, while assisting individuals regarding how best to provide needed documents and evidence required, and /or initiating inquires to resolve errors, delays, or other problems in obtaining benefits.

· Completing claim and appeal related work including, but are not limited to: compensation and pension benefits, home loan eligibility, education, health care, life insurance, burial benefits, vocational rehabilitation services, fiduciary assistance, general Social Security Administration benefit programs, and other Federal, state, and local domestic relations and assistance programs.

· Explains VBA rating decisions and provides explanations for the decisions using extensive knowledge of VA benefits and services, claim and appeal processing procedures, and all pertinent information available within the systems of record.

· Perform comprehensive claim or appeal status updates using mandatory scripting requirements, processing change of address requests, establishment of, or change to direct deposit banking information, burial allowance claims, dependency claims, etc.

· Assist Veterans and their family/friends/significant others during periods of crises to include potential suicide, homelessness, or financial hardship.

• Serves as the Medical Affirmative Claims (MAC) Technician and Examiner. -Responsible for the planning, organizing, and processing a variety of actions related to recovering revenue due to the government under the Federal Medical Care Recovery Act, the Federal Claims Collections Act and 10 USC 1095, as Implemented by AR 27-20 and AR 27-40, for the medical care of military personnel and their family members. -Knowledgeable of organizational policies to ensure compliance
• Keep abreast to changes oflocal medical facility regulations, SOP's, DoD and Army manuals and regulations (ICD 9-ICDIO) to ensure continuity of operations. -Conduct briefings/trainings for colleagues and leadership. -Responsible for preparing claims involving injuries to Active-Duty Service Members, Family Members, and Retirees to include their family members
• Assures medical/legal requirements, Joint Commission standards, and Army regulations are met. -Processes a variety of medical data pertaining to third party liability cases
• Coordinates with Recovery Judge Advocate (RJA), injured parties and attorneys, to ensure timely, concise and legal release of information.- Prepares, reviews, and process Medical Affirmative Claims (MAC) activities of billing in all areas of liability insurance, including automobile, homeowners and renters, general casualty, medical malpractice, and workers' compensation (for persons other than federal employee).
  - When individuals or Attorney offices call me about their case. I coordinate with JAG concerning their individual information.
  - Obtains and reviews resource documents such as Admission and Disposition, Emergency Room Reports, and Military Police reports.
  - When information is mailed to my office from an attorney or individual. I coordinate with JAG on how they want to receive via email or distribution mail.
  - I provide support to Staff Judge Advocate office in pursuing claim cases.
  - I coordinate with JAG to analyze problems within (ABACUS) to verified credentials needed for pursuing claim case for attorney's office.
  - Code close with medical claims with diseases, injuries, operations, and/or medical procedures in
  accordance with established coding regulation to ensure accuracy. Contact medical staff members to rectify deficiencies and/or discrepancies in the medical documentation. Ensure medical/legal requirement
  regulations are met.
  - Reviews supporting documents for completeness to include such substantial data as diagnosis, nature of treatment, itemization of all charges, and create bills through Armed Forces Billing and Collection Utilization Solution System (ABACUS). Obtain payment information from Tricare for care provided in civilian facilities.
  - I maintains files for Martin Army Hospital, Staff Judge Advocate office making sure credentials data is input with accuracy and completeness.
  - Research complex medical diagnoses utilizing proper coding. Utilized Professional Edition CPT Current Procedural Terminology to determine accurate coding. Identified various non-compliance issues. Ensured accurate information reflected to medical records by utilizing correct codes. Maintained and reviewed claims with medical records and diagnosis.
  - Provide claims forms with accurate cost computation to the Staff Judge Advocate (SJA) for assertion. Provide SJA copies of supporting medical records, system documentation, and billing back-up when requested.
  - Determine which individuals; agencies and offices should be contacted to complete development of the claim. This includes requesting information from the appropriate military treatment facilities, and Humana /Tricare office. Utilize Composite Health Care System (CHCS), Armed Forces Health Longitudinal Technology Application (AHLT A) and Essentris to ensure records contain accurate documentation by providing advice to medical staff.
  - Establishes a case file and uses the Armed Forces Billing and Collection Utilization Solution System
  (ABACUS) to maintain case files on each claim. Knowledgeable of diagnosis (ICD9-l 0) and procedure code (CPT4) coding methods to complete the billing process.
  - Monitors the status of each claim file and determines the appropriate time to follow-up with parties involved. Reviews information received to determine if further development of claims material is required. Reviews medical records for injuries and procedures in accordance with established coding regulation. Identified problems to medical coding by interpreting codes.
  - Utilizes graphs, spreadsheets, word processing, and presentation to gather, develop, and deliver
  coding/claim information.
  - Prepare monthly reports showing number of files opened, claims asserted, settled, and collected.
  - Analyze complex medical data using various medical terminologies.- Advised on improvements of coding procedures. Assisted staff with coding practices as needed. Assisted staff of briefings on entry level medical coding. Briefed clinical staff on coding and documentation.
  - Developed various reports to reflect coding data submitted to the Office of Staff Judge Advocate Claims (OSJA). Create resolutions due to discrepancies.
  - When entering providers information for billing into the (ABACUS) healthcare system. I can also review and check their credentials are up to date.
  - Research medical codes and patient information in the Ambulatory Data Module (ADM).
  - Utilize the current International Classification of Diseases (ICD), Clinical Modification; American Medical Association Current Procedural Terminology (CPT), Health Care Financing Administration Common Procedure Coding System (HCPCS) and Cyclopedic Medical Dictionary.

- Processed all phases of MSAO (Medical Service Accounting Office) insurance billing.
- Maintained medical services accounts which involve the direct handling of cash items collected for hospital charges, the preparation and maintenance of cash accountability and patient pay records, the verification of supporting documents and the preparation of daily reports.
- Tracked all potential sources from the date of the hospital and medical visits to billing completion. Research and determine appropriate itemized medical billing, using the DoD approved rates (i.e. CMAC (Campus Maximum Allowable Charges), DRG billing, and agency rates), ICD-9 (International Classification otDiseases-9), and CPT-4 (Current Procedural Terminology-4) for maximum reimbursement.
- Prepared and processed accounts from carriers such as DSHS, CV, and L & I.
- Communicated with the Emergency Room and other wards to check for pre-admission certificates and obtained authorization from the Utilization Review nurse.
- Maintained medical services accounts and Invitational Travel Orders (ITO) for foreign nationals and Coast Guard Personnel for billing purposes.
- Checked Defense Enrollment Eligibility Reporting System (DEERS) to verify patients are eligible for medical care (ER, Lab/Rad, Pharmacy, etc.) for patients without valid identification, prepare temporary authorization letters, delinquent letters, and payment status letters using Composite Health Care System (CHCS) and document using a Claims Action Log.
- Received, processed, and safeguarded direct handling of cash items and valuables belonging to patients while in the hospital using DA Form 3696 against discharge records and to document.
- Performed cash processing and teller duties involved in the receipt, disbursement, deposit, custody, accounting, collection, and processing of cash and cash items received by the MACH Treasurer's Office for hospital charges (hospital meals, dental prostheses) and for deposit into patient trust fund account. Managed the Patient's Trust Fund (PTF) accounts.
- Ensured payments are posted in General Fund Enterprise Business System (GFEBS) according to regulatory guidance Processed third party medical insurance claims for civilian emergency accounts and cost of inpatient care (verify insurance eligibility, prepare and submit/mail bills to third party insurance companies, maintain cash and accounts receivable journals, follow-up on accounts or until paid). Prepared invoice & receipt for payment to include accepting cash, checks, money orders, or vouchers at tellers' window or through mail for hospital charges.
- Created letters to patients and agencies regarding payment status, insurance deductible status, and appeals. Explained medical service accounting, hospital billing regulations and hospital policies relative to hospital charge rates, payment schedules, insurance claims, etc., to persons contesting, unable or unwilling to pay hospital bills, persons with language barriers (assisting foreign nationals in transactions by obtaining interpreters to assist them), persons delinquent on accounts Transferred delinquent accounts from Civilians or separated military personal to Financial Management Debt Service (FED DEBT).
- Coordinated and communicated with personnel/medical staff within the immediate units, MEDDAC, Finance and Accounting personnel and commercial bank offices to resolve discrepancies/issues.
- Responsible for the preparation and maintenance acceptability requirements of cash accountability records and supporting documents. Ensure that estimates are valid, accurate, and in balance with required rules, regulations, and procedures.
- Knowledgeable of basic principles, practices, and methods of the budget process, skill in extracting budget, and program data from computer printouts of accounting records, forms, and reports. Verified the cost of line items in the budget and enter the costs in standard forms and schedules. Prepared collection voucher for Financial Institution deposits.
- Responsible for verifying charges in the dining hall using the DA Form 3158 and inputting data into Composite Health Care System (CHCS). On a daily basis, collect reports of hospital visits made by personnel to Martin Army Community Hospital (MACH) clinics and Troop Medical Clinic (TMC). Compiled and enter patient data into automated system.
- Compiled a variety of recurring reports (e.g., monthly report showing breakdown of the various categories of patients and charges to each for hospital services).
- Collected, reported and analyzed data associated with services provided to beneficiaries including but not limited to beneficiary trends and systemic deficiencies to provide better customer service. Recommended courses of action to management to increase program efficiency and improve effectiveness.
- Proficient in the use of the Composite Health Care System (CHCS), Armed Forces Health Longitudinal Technology Application (AHL TA), Humana/ Tricare Information Portal, Armed Force Billing and Collection Utilization Solution (ABACUS), Ambulatory Data System (ADS) Over The Counter Network (OTCNET), and Collections Information Repository (CIR), Admission and Disposition (A&D).

- Acted as subject matter expert in guiding the 357th Infantry Brigade on question/answer sessions for family members preparing for movement of personal property to another geographical location.
- Conducted briefings on entitlements and procedures related to temporary storage of goods, weight allowances, prohibited items, and/or shipment of unaccompanied baggage, privately owned vehicles,and household goods Received and reviewed personal property inspection records for all domestic and international personal property shipments. Assisted in ensuring itineraries issued by travel service office corresponded with travel authorized.
- Evaluated data pertinent to shipment (i.e.: orders number, date of orders, accounting classification codes) instrumental in establishing scores for individual shipments according to compliance with regulations.
- Prepared paperwork to initiate, document, or complete transportation actions. Forwarded completed documents to contractors, maintained a suspense file for incomplete finance documents. Created,Provided information on TQAP, outbound shipments schedules, non-temporary storage; receive non­temporary storage, DPM contractual invoices, and Statement of Accessorial Services performed.
Reviewed cost estimates to assist the customer in determining the best method of movement and verified the lowest contract fare is obtained or exceptions are authorized for shipments. Confirmed charges utilizing tariffs, rate tenders, contacts, and rate solicitations.
Validated and received rate copies of Government Bill of Lading Statement from agents, and update -information TOPS systems.
Resolved issues between provider and customer during emergency transportation situations.
Initiated action to resolve billing complaints, problems, concerns and discrepancies pertaining to contract transportation. File reports 1780 and 1840 for remedy. Scored all carriers servicing this organization (timely process documentation) and promptly initiate punitive actions (LOW or Suspension) on all outbound carriers demonstrating substandard performance.
Reviewed carriers' files for trends or patterns and prepared a letter to carrier informing of trends noted; maintained and evaluated carrier performance using TQAP for Outbound Domestic
Shipments/Outbound International Shipment.
Reconciled bills related to transportation actions certifying actions are in compliance with regulatory guidance.
Printed suspense files and annotated violation by coding appropriate points under TQAP Date sheets.

- Exercised the full range of supervisory responsibilities; recruitment efforts, interviewing/hiring, creating/entering personnel actions, performance management, creating staff schedules, and counseling actions to include disciplinary infractions.
- Coordinated, scheduled and maintained personnel trainings/timesheets for a department of 10. Maintained employee records and assisted all personnel with leave requests, business travel, in-processing and out-processing.
- Conducted safety stand downs briefings at the beginning and end of shift.
- Prepared an annual budget; scheduled expenditures; analyzed variances; and initiated corrective actions.
- Formulated pricing policies and ensured pricing is correct. Maintained inventory and ensure items are in stock.
- Ensured promotions are accurate and merchandised to the company's standards Utilized information technology to record sales figures, for data analysis and forward planning.
- Analyzed accounting data and perform research required to correct system generated errors and process into the accounting system. Opened and closed retail store and ensure hours of operation are in compliance with local laws. Maintained store's cleanliness and health and safety measures.Handled and resolved customer questions, complaints, and issues.

- Reviewed estimates submitted by Program Managers for compliance utilizing standard operating procedures, regulations, and procedures.
- Responsible for maintaining the accounts receivable aging for certain customers, receiving incoming customer payments, entering cash receipts and completing bank deposits.
- Maintained accounts for the subsistence, supplemental, and operational supply accounts.
- Coded daily sales report and checks to appropriate general ledger account.
- Reconciled discrepancies by reviewing completed transactions.
- Performed account, general ledger and sub-ledger systems reconciliations. Verified, balanced, and reconciled supporting documentation files with listing and reports.
- Communicated with customers (verbally, via email, letter or fax) to reconcile customer accounts. Communications involved requesting past due payments and clarifying chargebacks, deductions, and allowances.
- Researched, verified and analyzed returns, proof of delivery, shortages and allowances with Customer Service, Shipping, and Salesmen.
- Analyzed accounting data and perform research required to correct system generated errors and process into accounting system.
- Assisted with month-end and year closings and will be required to prepare various excel reports. Performed accounting clerical duties such as filing, making collections phone calls and sending out past due correspondence.
- Responsible for such other duties and assignments which the Company deems appropriate.