Katrinia Jones-Looney

Performed insurance verification to assure coverage and patient responsibility using EPIC and Availity systems. Re-submitted claims to insurance companies to resolve denials and EOB rejections. Managed all payment processing, invoicing and collections tasks. Accurately posted payments received using POS Corp system. Engaged in conversation with customers to understand needs, resolve issues while answering billing and insurance questions. Maintained detailed records of customer interactions in customer relations management database. Received inbound calls, chats and emails to facilitate customer service.

Performed data entry of health and dental claim information via QCARE, PEGA, Claims Xten systems for processing. Evaluated pending claims to identify/resolve problems blocking auto-adjudication. Evaluated denials received from third-party payers to determined if they were valid or should be appealed. Maintained knowledge of current dental industry trends, including changes in regulations, coding systems, reimbursement policies. On the job certified and trained in ICD9/10 CPT CMS, HCPS coding. Assisted in meeting daily, monthly targets and quality standards achieving company accuracy 95-100%.

Set up and activated customer accounts. Engaged in conversation with customers to understand needs, resolve issues and answer product questions. Upheld quality control policies and procedures to increase customer satisfaction. Answered inbound calls, chats and emails to facilitate customer service. Processed STD claims weekly, maintained excellent records to ensure accurate, timely payments. Worked with cross-functional teams to achieve goals. Completed day-to-day duties accurately and efficiently.