Summary
Overview
Work History
Education
Skills
Timeline
Generic

Francesca Cocco

Menifee,CA

Summary

Medical Claims Professional ACD Call Center Customer Service Skills Claims Processing Lotus 123 Medi-Cal claims processing Interpret Provider contracts Commercial claims processingAll Windows Applications, MS Office, Typing (55wpm), Data Entry, SAP, Centricity, MHC Medical Billing Read, interpret and summarize medical contracts/division of responsibility before allowance of payments. Claims processing

Overview

21
21
years of professional experience

Work History

- Patient Account Representative Customer Service

Tegria
01.2021 - 02.2022
  • Resolving inbound customer service calls from patients in the call queue
  • Taking appropriate action on related accounts in a timely manner while upholding a high level of accuracy
  • Rebill Medical Claims
  • Reviewing incoming correspondence, taking appropriate action by updating the respective accounts
  • Maintaining effective communication with assigned client contacts regarding issues related to assigned accountabilities
  • Communicating with attorneys Summarizing your findings for each PI lien case for both internal and client-facing communication
  • Established relationships with customers to encourage payment of delinquent accounts.
  • Worked with customer to create debt repayment plan based on current financial condition.
  • Researched billing errors and discrepancies to initiate corrective action.
  • Electronically submitted bills according to compliance guidelines.
  • Generated and distributed monthly customer statements.
  • Posted payments and processed refunds.
  • Monitored customer accounts for payment delinquency and initiated collection efforts.
  • Contacted patients after insurance was calculated to obtain payments.

Risk Claims Examiner

Loma Linda University Health, Hospital
04.2018 - 09.2019
  • Batch and prioritize a minimum of 75 Hospital / Institution claims processing per day utilizing the company’s in-house claims processing system
  • Verify patient’s accounts for eligibility and benefits
  • Process complex claims that have been accepted for payment
  • Request and follow-up on additional information as needed for incomplete claims
  • Complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame
  • Assemble denial letter background information and generate denial letters
  • Read, interpret and summarize medical contracts/division of responsibility before allowance of payments
  • Identify claims.

Claims Examiner

L.A. Care Health Plan
03.2015 - 11.2017
  • (Local Initiative Health Authority of Los Angeles County), Claims processing to ensure quality (in/outpatient hospital claims)
  • Adjudicate claims in accordance with Managed Care Operations and CMS and DMHC Guidelines
  • Follow the eligibility research protocol including verifying member benefits and COB
  • Review authorization status codes and notes affecting the adjudication of the claim
  • Submits claims to UM per protocol
  • Complete all required fields and keying appropriate CPT& DX codes
  • Apply provider contract rates appropriately based on effective dates and amendment updates
  • Process claims according to the applicable Health Plan Division of Financial Responsibility matrix
  • Scan appropriate documentation with claims
  • Research and resolve customer service issues in a timely manner to ensure quality claims service
  • Meet productivity and error ratio standards as required
  • Apply payment rules regarding modifier and CPT code guidelines
  • Knowledge of Medi-Cal Fee Schedule
  • Processed Skilled Nursing Claims
  • Care 1st Health Plan Medical Claims/Medical Claims Customer

02.2014 - 02.2015
  • High Call Volume call center Environment
  • Reviews each claim to make the appropriate determination on the next course of action;
  • Pay and/or adjust claims which can then be processed, determines claims situations that need to be transferred or rejects claims that cannot be processed or are contract exclusions
  • Provide assistance, service and education to all internal and external members, providers, and customers
  • Ensure accuracy and timeliness in responding to a variety of inquiries
  • Process and resolve customer issues with varying complexities, which may include system updates.

Customer Service

Medtronic’s Patient Financial Services
09.2006 - 08.2011
  • High Call Volume call center Environment
  • Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes
  • Obtaining and updating patient demographics and financial information
  • Researching patients’ accounts for payments and credits
  • Using our state-of-the-art technology to toggle between 3-5 systems at any given time
  • Accepting monthly payments or setting up payment plans as needed
  • Negotiating effectively with patients to coordinate payment plans
  • Handling special requests and verifying quality care on each call as well as handling insurance information
  • Adhering to state and federal collection laws
  • Assertive and tactful co-pay, deductible, co-insurance and patient balance collection on all accounts.

Claims Examiner

Health Net
03.2001 - 02.2004
  • Processed all Claims Eligible or Ineligible for payment accurately and conforming to quality
  • Production Standard and Specifications in a timely manner
  • Coordination of Benefits with Medicare and other Insurance Carriers
  • Matched Authorizations to Claims and Maintained Current Desk Procedures
  • Reviewed Appeals and Complaints; researched any missing or required information
  • Knowledge of Managed Care Industry; Medical Terminology; Standard Claim Forms and Physician Billing Coding; ability to read/interpret Benefit Contracts; Standard Reference; ICD-9, etc.

Customer Service

HEALTH NET
09.2000 - 03.2001
  • High Volume call Center
  • Speaking with customers (policyholders), assisting with questions they may have regarding their health insurance policy, claims they may have, or any other general questions regarding information on providers
  • Handling provider calls about patient policy holders’ coverage
  • Responding to grievances, complaints, or appeals
  • Seeking assistance with complex customer issues.

Education

High School Diploma - undefined

Burbank High School, North Hollywood Dental Assisting School

Skills

  • Account Resolutions
  • Terms Review and Enforcement
  • AR Aging Reports
  • Microsoft Office

Timeline

- Patient Account Representative Customer Service

Tegria
01.2021 - 02.2022

Risk Claims Examiner

Loma Linda University Health, Hospital
04.2018 - 09.2019

Claims Examiner

L.A. Care Health Plan
03.2015 - 11.2017

02.2014 - 02.2015

Customer Service

Medtronic’s Patient Financial Services
09.2006 - 08.2011

Claims Examiner

Health Net
03.2001 - 02.2004

Customer Service

HEALTH NET
09.2000 - 03.2001

High School Diploma - undefined

Burbank High School, North Hollywood Dental Assisting School
Francesca Cocco