Jovan Lynch

• Manual Labor
• Unloading Product
• Assist in the material assembly process
• Maintained cleanliness and organization of work areas to promote safety standards.

• Adjudicate claims received into processing system
• Thoroughly reviews, investigates and adjudicates claims daily, working oldest to newest claim in 30 days or less, and 98% of the time
• The claims are processed accurately as defined by standard guidelines
• The claims should be adjudicated with a 98% procedural accuracy rate monthly as reviewed by weekly audit reports
• Special projects as requested
• Examiner should process a minimum of 14 claims per hour, or a minimum of 98 claims per day
• The claims should be adjudicated with a 98% accuracy rate monthly as reviewed by returned claims for adjustment review
• Conducts review and investigation of pended claims and follow up with internal and external departments to finalize claims resolution within 30 days
• The claims that are manually adjudicated must have notes entered as reviewed by weekly audits, check run, returned claims, management review 98% of the time
• Access requests are processed within 30 days of receipt, with a 98% accuracy, to ensure timely resolution of claims, in adherence with HHSC regulatory requirements

Spears Manufactering

• Responsible for inspecting and bagging of pvc pipe. Pipe must meet company standard.
• Operate forklift.
• Transport bagged pipe to loading area.
• Pipe disposal.
• Spears manufacturing- Sept 2019-March-2020

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• Stack boxes on pallet according to batch number
• Scan each box according to batch number
• Scan books into proper box based on batch number

• Responsible for the accurate and timely processing of claims. Must meet published quality and productivity standards. Also, responsible for adjustments to previously processed claims.
• Reviews, evaluates and adjudicates claims not automatically adjudicated by the processing system according to productivity and quality standards.
• Interprets and processes routine claims.
• Reviews and analyzes data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication.
• Alerts claims management to claims aging issues as well as provider billing problems.
• Maintains current knowledge of BMCHP member’s benefits, policies/procedures, provider network development and contract issues, processing system issues, Massachusetts Medicaid regulations, as well as industry standards for claims adjudication.
• (Claims Supervisor John Forsythe: 978-726-9452) (Claims Supervisor Donald Desilus: 617-704-3800)

• Pre scanning claims preparation, this includes sorting claims according to configured form families in AnyDoc
• Quality control inspection of imaged documents , and ability to resolve scanning issues within Anydoc and Onbase software
• OCR (optical character recognition) validation and indexing, validates text files for consistency to allow for the import of claims documents into Onbase
• Performs all duties assigned and taking on special projects
• Provides DCN request for all departments such as Appeals, COB, CLAIMS, PROVIDER AUDIT,CALL CENTER
• (Mailroom Supervisor Donald Desilus: 617-704-3800)

• Assists in bringing clients to and from Day program.
• Ensures the safety of all passengers while on the van.
• Responsible for clients belongings
• Keeps updated on Safety measures
• (Operation Manager Val: 617-876-0444)

• Opens all the mail that comes in
• Sort Medical Claims CMS1500/UB04/APPEALS/COBS/CORRECTED Claims, according to their Batch type, barcode/stamp each claim. Then ships FedEx to be processed scanned by a third party.
• Ships and receives Medical claims.
• Folding jobs
• Copy jobs