Eboni Young

• Resolved any issues arising from incorrect or incomplete documentation relating to a particular claim.
• Communicated frequently with healthcare providers regarding payment status updates on their claims submitted.
• Identified coding issues with bundling edits M15 and N19. Collaborated with coding on utilization of NCCI procedure to procedure edits resulting in claim turnover of additional payment.
• Managed M15 and N19 denial WQ.
• Utilized best judgement and thorough research to determine best steps to move claims closer to resolution.
• Completed special projects such as recoup report.
• Escalated complex denials to leadership.
• Updated account records accurately in the billing system.
• Researched discrepancies in patient accounts to determine appropriate resolution.

• Managed patient account inquiries and resolved billing issues efficiently.
• Reviewed EOBs statements submitted by insurance companies for accuracy against provider's charges.
• Verified accuracy of medical coding for services rendered by healthcare providers.
• Resolved any issues arising from incorrect or incomplete documentation relating to a particular claim.
• Maintained detailed notes on all patient interactions for future reference purposes.
• Communicated frequently with healthcare providers regarding payment status updates on their claims submitted.

• Analyzed and resolved denied medical claims from various payers (Medicare, Medicaid, commercial)

• Accurately posted payments, adjustments, and denials into the billing system (Epic, NextGen, eClinicalWorks)

• Communicated with insurance companies and patients to resolve outstanding balances and disputes

• Generated and reviewed aging reports, ensuring timely follow-up on unpaid claims

• Collaborated with coding and billing departments to reduce future denials

• Delivered customer support via phone or email, addressing inquiries about compressor systems to ensure client satisfaction.
• Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
• Performed data entry tasks for customer support requests.
• Collaborated with clients to resolve customer support inquiries, identify root causes of recurring issues, and refine procedures to enhance service quality.
• Resolved escalated customer support inquiries by investigating issues and applying established guidelines to meet customer needs.

• Identified claim trends for processes improvement.

• Managed daily denial inventory by physician.

• Utilized QNXT for line by line edits benefit detail, CPT pricing for FFS, benefit SNF days used and DME same/similar.

• Conducted regular ICD 10 crosswalk checks and plan benefit details to resolve claim denials.

• Communicated with healthcare providers to gather necessary documentation for appeals and ongoing education of provider resources.
• Requested medical records and corrected UB-04 and CMS 1500 claims as necessary from providers.
• Analyzed case files to determine compliance with company policies and guidelines.
• Adept at utilizing best judgment within processes.
• Reviewed and evaluated claims to determine if they meet the insurance criteria for reimbursement.
• Examined automobile policies with third-party liability, accident benefits, and collision benefits.

Submitted appeals on behalf of members after review of denied claims.