Liliana Tejada

Review and resolve claim edits in SSI

Work payer rejected claims for resubmission

Work reports and billing requests

Knowledgeable of standard bill forms and filling requirement

Knowledgeable of electronic claims editing and submission

Collect and provide patient and payor information to facilitate account resolution

• Responsible for Managed Medicare Accounts Receivable(A/R) follow up, denials, adjustments, credits and update account information accordingly
• Validate claim payments to ensure proper reimbursement and patient responsibility
• Eligibility verification

• Responsible for working claim edits, DNB errors and Stop Bills
• Reviewed and worked upfront rejections
• Reviewed and corrected RTP Medicare claims
• Responsible for Medicare and Managed Medicare claims collections and reimbursement services
• Validated claims payments
• Reviewed and worked correspondence

• Responsible for Commercial accounts Receivable(A/R) follow up for both contracted and non-contracted payers and update accounts accordingly
• Analyze patient accounts to determine accuracy of balance to ensure correct payment and adjustments have been applied
• Review incoming correspondence and take appropriate action

• Analyzed accounts for adjustments, credits, and errors, issuing corrected entries when necessary. Update account information accordingly
• Reviewed and verify claims in DDE
• Validated claim payments to ensure proper reimbursement and patient responsibility
• Provided effective and timely account resolution to ensure successful recovery

• Worked daily rejections generated by the clearinghouse such as CCI edits and LCD edits
• Electronically submitted claims according to compliance guidelines
• Analyzed accounts to determine accuracy of balances to ensure correct payment and adjustments have been applied
• Reviewed and submitted appeals and reconsiderations
• Reviewed correspondence, denials and take appropriate action
• Interpreted contracts between clients and insurance companies
• Communicate with payers when necessary to facilitate reimbursement
• Knowledge of modifiers, ICD-9/10, HCPCS, CPT and DRG

• Answered incoming phone calls from members and providers to provide claim status
• Answered incoming phone calls to quote member's benefits and eligibility
• Prepared and sent patient statements and EOB's

• Verified and entered patient and insurance demographics
• Posted payments and collections
• Created and mailed out patient statements
• Evaluated patient's financial status and established budget payment plans
• Reviewed and submitted electronically/paper claims to payers