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
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