Dominique S Scarlet

Collaborated with team members to achieve departmental goals and maximize revenue generation

Surpass $80 million dollar 4th quarter goal in 2022

Verifies appropriate CPT, ICD, and HCPCS codes to accurately file corrected claims for service

Effectively handles denials/appeals for inpatient/outpatient claims billed incorrectly or under expected reimbursement

Communicates with CMS providers and other medical billing professionals regarding billing related scenarios for effective billing processes

Actively maintains knowledge for CMS billing regulations and federal guidelines to avoid audit related penalties

Reviews EOB to ensure full provider reimbursement and applies patient/insurance responsibility

Increase productivity

Deadline driven Prior Authorization Analyst with training in clinical and laboratory

Acquired insurance authorizations for procedures and tests ordered by the attending physician

Strong attention to detail and extensive knowledge of medical terminology with help of CPT code abbreviations and ICD-10

Extensive understanding of contract, Medicaid and Medicare reimbursement

Thoroughly investigated past due invoices and minimized number of unpaid retro accounts with notification faxes with Utilization Review Department

Remained up to date with all insurance requirements, including the details of patient financial responsibilities, fee for service and managed care plans

Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient

Prepared and attached all required claims documentation including referrals, prior authorizations or other required correspondence to reduce incidence of denials

Work closely with Claims and Follow Up Department

Ensure 100% customer satisfaction by ensuring that customers are acknowledge, customer needs are met, and concerns are resolved

Assist high volume callers about locations, functions and services of departments

Exercises considerable judgement, discretion and interpretive ability in deterring the needs of caller and visitors

Identifies potentially dangerous or disturbed persons and takes appropriate actions according to medical office/hospital policies and procedures

Delivers knowledge of claims and authorizations benefits and claims processing from insurance companies and plans both private and government

Refers pharmaceutical Prior-Authorization request that require clinical judgement for Clinician or Medical Director

Coordinated billing and prepares statistical summaries for billing purposes, work activity of department, technical data and reports

Performs necessary information for coding with assigned diagnoses with use of ICD-9,10 handbooks

Schedules meetings, appointment and supervision for both staff and clients; maintains schedules of activities and location of staff members as required