Erica Washington

• Reimbursement and/or resolution of patient claims.
• Completed follow-up on accounts to maximize reimbursement.
• Insurance Account Follow-up (hospital or physician)
• Focus on claims denied by insurance carriers or paid incorrectly.

• Processing claims where different edits prevent claims from paying.
• Resolve edits where it calls for verification of information on CMS 1500.
• Changed addresses/ Profile updates.
• Used look up tool to find information on patients.

• Supported payment dispute process across all lines of business.
• Resolution of payment reconsideration requests from Providers.
• Reviewed provider requests to investigate claim payment denial.
• Determined appropriate resolution using strict adherence to internal guidelines.

• Processed Co-Pay debit cards for patients with chronic conditions.
• Managing inbound/Outbound calls to/from patients
• Explain important safety and usage information
• Gathering Medical/Pharmacy information to determine qualifications.

· Responsible for handling over payment,

· Determined and calculated amount of over payment.

· Issued refund request letters, and notice letters.

· Processed voluntary refunds.

· Adjusted claims based on refund received.

· Investigated and facilitated resolution of claim issues

· Worked with multiple operational areas such as health plans, provider information

management, benefits configuration and/or claims processing

· Coordinated efforts of several internal departments to determine proper resolution of issues within strict timelines

· Interacted with network providers and health plans regularly to manage customer

expectations, communicate risks and status updates, and ensure issues are fully resolved