Dominique Thomas

(Contract Position)

• Working directly with providers and health plans to identify and resolve claims processing and service concerns
• Documenting all notes in VUE360 with providers in regards to why the claim paid or denied, and with health plan representatives
• Verifying members medicaid eligibility and benefits
• Advising if specific CPT codes are covered or requires a prior auth
• Assisting providers with the correct information in order to have the claim corrected and sent over back for reprocessing
• Research and review Claims Appeals information to support client inquiries
• Maintain strict confidentiality/privacy of patients' protect health information in accordance with HIPAA regulations
• Following all call handling requirements.

(Contract Position)

• Epic trained
• Update accounts with new or corrected information; request itemized statements; &/or re-bill claims when appropriate
• Explain medical bills and identify deductibles, coinsurance, copays and other patient financial responsibilities
• Manage all interactions in a positive, caring manner
• Perform specialized tasks as assigned by the manager and/or supervisor
• Maintaining patient records, which includes updating payment information and medical insurance information
• Creating suitable payment plans for patients based on their monthly income and financial obligations
• Processing patient payments and refunds
• Identifying medical coding mistakes, typing errors, as well as patient underpayments or overpayments and rectifying them accordingly
• Answering patients' questions regarding unsettled medical bills, reimbursements, and billing discrepancies
• Order medical records via phone, fax and/or letters as requested and view the medical and treatment history of the patients
• (EMR)
• Answering early out calls in regards to patients paying their outstanding balance
• Assisting patients by helping them remove their account from a bad debt status by making a payment.

(Contract Position)

• Answered inbound patient scheduling calls based on the department, and address their concerns in a satisfactory manner
• Communicated with patients to schedule, re-schedule and/or cancel their appointment requests accurately by following practice scheduling protocols and tools
• Accurately collected and performed data entry of all required patient demographic and insurance information
• Using professional communication etiquette and listening skills to assist patients with their scheduling needs
• Building safe and trustworthy environment with patients by utilizing both a scripted and non-scripted communication methods
• De-escalate situations involving dissatisfied customers, offering patient assistance and support
• Utilize and maneuver between several different software systems
• Maintained confidentiality of account information at all times
• Handling all appointments in the practice, even across multiple locations.

• (Prior Authorization)
• Responsible for providing specialized information on a variety of matters relating to the processing of prior authorizations
• Processing, communicating, documenting and tracking requests for prior authorizations for delegated products and services
• Review criteria to determine if the request can be approved or denied
• Accurately entering prior authorizations in claims system
• Provide clinical outcome to the member and the member's physician within client specific turnaround times
• Research and respond to calls and emails
• Converted CPT codes scheduled by physicians to the corresponding ICD-10 codes
• Perform outreach to pharmacies and physician's offices to obtain all necessary information
• Responsible for accurately entering important data and keeping records up-to-date
• Performed high-volume data entry using word processing, spreadsheet, database
• Reviewed data for errors, missing pages, or missing information and resolved any discrepancies.

• Distributed medications to patients, inputting prescriptions in a timely manner, handled cash, stock and inventory for medications, assisted the pharmacist in identifying fraudulent prescriptions, worked as a liaison for the patient and the insurance company for prior authorizations
• Worked in a call center based environment
• Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists
• Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments
• Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient
• Reviewed and verified customer information and insurance provider information
• Communicated instructions to patients or caregiver's.