Heather D'Agostino
Fairborn,Ohio
Summary
Analytical Claims Adjudicator with 6.5 years of positive experience. Adept at performing data acquisition and analysis to validate insurance claims. Bringing in-depth knowledge of claims negotiation and document processing to contribute positively to Caresource's growth and development.
Overview
6
6
years of professional experience
Work History
Claims Adjudicator
Caresource
07.2019 - 11.2023
- Accurately processing claims for behavioral health and Ohio Medicaid.
- Accurately processing in assisting with P4HB in Georgia.
- Accurately processing and assisting with IN Medicaid and Marketplace claims.
- Working Senior responsibilities in auditing claims completed by the team while senior position was vacant.
- Accurately working Millers DME Claims
- Accurately working OH Medicaid Consent Claims.
- Accurately working claims in Onbase
- Auditing Consent claims for OH Medicaid
- Accurately working SNF Claims for OH Medicaid
- Worked a special project for appeals. Uploading documentation, creating appeals in guiding care and documentation. Transferring that information and processing claims as needed to appeals decisions.
- Accurately processing AR PASSE Claims
- Assisting with MI HAP Claims and pending for review of agreements.
- Working special project - Post Prod Review audit
- Processing claims with a limit of 1 audit error per month, exceeding that to only having 2 errors since start of position.
- Working to process 124 CPH (Claims per hour) Exceeding to actually working 139 CPH
- Assisting the team with questions and applying my knowledge to help them process claims.
- Knowledge in facets, streamline, and Onbase.
Provider Service Representative
Caresource
06.2017 - 07.2019
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
- Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
- Improved communication between providers and insurance companies, leading to better understanding of policy coverage and claim status.
- Worked the Behavior Health Redesign with providers and solved issues.
- Knowledge in the following Lines of BUsiness: Medicaid: Kentucky, Ohio, Georgia. Marketplace: Indiana, Kentucky, Ohio, and West Virginia. Mycare for Ohio. Medicare Advantage for Ohio and Kentucky. Behavioral Health Redesign for Ohio.
Education
Certification - Medical Coding And Billing Specialist
Sinclair Community College
Dayton, Ohio06.2017
Certificate - Pharmacy Technician
Sinlair Community College
Dayton, Ohio12.2016
Skills
- Knowledgeable in Microsoft word One note, excel, word, powerpoint
- Knowledgeable in Facets and in Onbase
- Claims Management
- Data Verification
- Research and Data Analysis
- Organizational skills
- Conflict resolution
- Adaptability
- Insurance knowledge
- Decision-making abilities
- Continuous learning
- Customer service
- Computer proficiency
- Team collaboration
Hobbies
Current 9 year Girl Scout leader to a wide range of girls from grades Kindergarten to 8th grade.
Timeline
Claims Adjudicator
Caresource
07.2019 - 11.2023
Provider Service Representative
Caresource
06.2017 - 07.2019
Certification - Medical Coding And Billing Specialist
Sinclair Community College
Certificate - Pharmacy Technician
Sinlair Community College
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