LINDA PEPPER

*Posting medical insurance payments to patient accounts.

*Reviewing the contracted rates on procedures, and the insurance companies stipulations.

*Correcting electronic EDI payments that do not process correctly. *Manual posting of paper remits that are received. Posting adjustments as needed.

*Auditing credits on patient accounts to determine if a refund is warranted. Review of accounts when requested by customer service. Other duties as assigned.

• Working follow up from an aging report, contacting insurance companies for status of aging claims, denials, etc.
• Responding to medical records requests from insurance companies.
• Occasional patient contact via phone or in person to review their account.
• Writing letters of appeal on denied or underpaid claims.
• Correcting EDI claims that need errors fixed.

• Posting medical insurance payments and denials.
• Posting patient payments.
• Running claims aging report and following up on denied or underpaid claims.
• Submitting requested medical records to insurance companies.
• Fixing claim errors needed in the EDI exchange so they will get to the insurance carrier.
• Assisted co-workers on difficult account adjustments.

• Submitting claims electronically or on paper to insurance companies.
• Posting insurance and patient payments received electronically or by paper.
• Filing reconsiderations or appeals on denied or underpaid claims.
• Correcting EDI errors on claims that fail to transmit to the insurance carrier.
• Other duties as assigned.

• Follow up with insurance companies on pending or denied claims.
• Sending requested medical records.
• Posting contractual adjustments.
• Other duties as assigned.

• Temporary assignment of coding and submitting eyecare claims to insurance companies.
• Worked report of rejected claims to fix so they will get to the insurance canter electronically.
• Other duties as assigned.

• Processing of Medicare Advantage claims, paper and electronic.
• Customer service with patients and providers to answer claims payment reasoning.
• Handling of complex claims, interim hospital billing, and assisted the trainer.
• Tested the claims payment system after updates were applied by the system to make sure the correct adjustment were applied, deductible, etc.

• Correcting claims flagged for possible errors, coding and frequency limitations, etc.
• Either recommended payment or denial to the claims department or sending to our clinical review department for their review.

• Internship after medical coding and billing classes.
• Assisted in the billing and clinical office.

• Auditing claims for reimbursement requests from Third Party Administrators with Specific and Aggregate deductibles.
• Duties included auditing accuracy of the TPA's payments or denials using the Certificate of Coverage.
• Estimation of future costs of the patient's treatments.

• Processing of Medicare Advantage claims, paper and electronic.
• Customer service with patients and providers to answer claims payment reasoning.
• Handling of complex claims, interim hospital billing, and assisted the trainer.
• Tested the claims payment system after updates were applied by the system to make sure the correct adjustment were applied, deductible, etc.

• Processing of medical, dental, and vision claims.
• Also processed short term disability claims.
• Applied contractual adjustments and applied benefits according to the Certificate of Coverage.
• Telephone customer service.