Mary York

Claims Investigator experienced in health insurance claims adjudication and data analysis. Resolved complex claims through strong decision-making skills and in-depth knowledge of billing codes and regulatory standards. Focused on delivering compliance and enhancing team performance through effective communication.

• Manage patient appointment scheduling, ensuring timely and courteous responses to calls.
• Confirm appointment details and necessary preparations with patients and representatives.
• Assist other schedulers and handle incoming calls to streamline workflow.
• Provide empathetic support to patients, addressing concerns and offering clear instructions. Enhance overall patient experience and satisfaction.
• Meticulously verified physician orders, ensuring accuracy of CPT and diagnosis codes. Obtained necessary authorizations, maintaining compliance with healthcare regulations.
• Ensured compliance with policies for durable medical equipment, ambulance, and dental services.
• Engaged with internal and external customers, enhancing communication and response efficiency.
• Investigated claims, analyzed medical records, and determined cases for medical review.
• Responded to inquiries from providers, members, and vendors, ensuring accurate information exchange.
• Documented and filed records accurately in appropriate systems, maintaining data integrity.
• Handled member and provider inquiries, enhancing satisfaction and resolution rates.
• Assisted supervisors with escalated issues, improving callback efficiency.
• Served as lead contact for non-par balance billing issues, ensuring clear communication.
• Provided critical information on GEHA networks, aiding in network-related issue resolution.
• Maintained meticulous records of customer interactions, ensuring accurate documentation for future reference and continuous improvement.