Erica Frazier

Research and process claims according the processing guidelines and benefits. Contact and follow up with members for additional correspondence. Responsible for accurate and timely daily reports. Assists with the training of new hires. Third Party Administrator knowledge and experience. Knowledge and use of ICD-9, ICD-10 and CPT coding

Review and verify medical claims for accurate information, including patient demographics, diagnosis codes, and procedural codes.
Determine coverage eligibility and benefits by liaising with insurance companies and patients.
Ensure compliance with HIPAA regulations and insurance policies during the claims processing.
Resolve claim discrepancies and denials by investigating and communicating with relevant parties.
Maintain organized records of claims, payments, and related documents for audit purposes.
Collaborate with medical coders and billers to ensure accurate coding and billing practices.
Identify and report fraudulent claims to the appropriate authorities.

Caught fraudulent activity more quickly and efficiently, leading to a drop in cost of fraud to the customer by nearly 96% and a drop in the cost of goods sold by over 95%.Provided additional analyses where needed to determine inefficiencies within the department and implemented the fixes to these problems. Created ad-hoc Access queries to provide quick and precise answers to various customer and vendor requests. Given a much expanded role within the department including as an analyst of customer credit-risk. Internally led a class in training of basic Microsoft Excel.

Provided independent decision making skills and demonstrated initiatives to resolve issues for internal and external customers. Answered incoming calls while handling in-person inquiries Composed and typed routine letters and documented file activity on a regular basis on the computer Processed and handled new non technical claims. Performed clerical functions which included opening, sorting and distributing incoming mail and processing outgoing mail, copy work, handled office subpoenas, filing and assisted the unit and supervisor in multiple projects using expert time management with little supervision Paid vendor statements and handled payment complaints and discrepancies. Processed checks, stop payments, cancellations, voids and journal entry payments and scheduled appointments.