Lusine Shmavonyan

Responsibilities:

• Support case managers on FL Health Services Medicaid Long-Term Care team
• Faxed forms to FL Department of Children & Families (review form for accuracy and fax to DCF)
• Document activity in Community Care and maintain fax copies in Doc360
• Verify PASRR forms on file for nursing home members
• Updated entries in SharePoint lists.
• Monitored compliance with HIPAA regulations in regards to patient privacy rights.

• Quality control
• Evaluate the eligibility of applicants seeking a healthcare policy
• Reviewing applications for coverage to ensure they meet all
• Prepared detailed reports summarizing findings and recommendations for coverage eligibility
• Conducted interviews with physicians and other healthcare providers to obtain additional information regarding the applicant's medical condition.
• Evaluated claims data to determine the extent of benefits available under various policies.
• Assessed financial risks associated with new policies by analyzing customer applications and related documents
• Identified potential fraud or abuse by reviewing claims activity for patterns of suspicious behavior
• Drafted letters informing clients of approval and denial status along with explanation of rationale behind decision making process
• Maintained accurate records related to underwriting activities including review notes, correspondence

• Provided administrative support such as typing documents, filing paperwork, photocopying, scanning documents, and faxing documents
• Answered phone calls in a professional manner and transferred calls accordingly
• Created spreadsheets using Microsoft Excel for tracking data and creating reports
• Updated customer accounts information in the database system accurately
• Verified insurance coverage and identified third-party payers for billing purposes
• Investigated incorrect billings and processed refunds as necessary
• Maintained accurate records of collections, adjustments and denials in the system

• Attention to details; Multitasking; Excellent communication ability;
• Exelaint customer service; Computer knowledge; Process refund requests; Applying Payments from Patients and Insurances;
• Checking eligibility; Process billing calls and questions from patients and third party carriers;
• Perform follow up with Medicare Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports;
• Communicate daily with internal and external customers via phone calls and written communications;
• Maintain patient confidence and protects medical office operations by keeping patient information confidential;
• Being comfortable with teamwork