Michelle Lloyd

Job Responsibilities:

• Setting up, Examination of received documents, payment calculations and settlement.
• Detail oriented review of claims before payment is processed.
• Eligibility verification of members claim/treatment/care.
• Perform additional adjudication covering review of medical history before proceeding with medical benefits.
• Supporting different sets of Health Claims products including but not limited to: Wellness, Critical Illness, Accident, Cancer, HI, Life and Death Claims.
• Processing claims in Lifesys, accessing medical records in image portal, requesting medical records as needed through perameds.

• Managing events for volunteers to attend
• Collaborating with coordinators in our office with different projects
• Sending Emails as needed
• Answering and routing phone calls
• Organizing and ordering trinkets for different volunteer events
• Running month reports on registration of organ donors
• Scheduling travel for mangers and coordinators
• Setting up zoom meetings for management and coordinators
• Mailing out supplies for volunteers and tax collector offices.

• Performs various collection actions including; contact with insurance companies and patients by phone
• Reviews zero pay accounts to determine proper handling
• Correcting and resubmitting claims to various carriers if applicable
• Provides requested information to carriers to complete claim processing
• Answers questions from patients, clerical staff and insurance companies
• Identifies and resolves patient billing complaints
• Prepares and reviews accounts for payments made to patients
• Follows protocol for notification to patients for payments made directly to them
• Follows and reports status of delinquent accounts
• Allots time each day to work clearinghouse rejected dashboard
• Participates in educational activities and attends staff meetings
• Conducts self in accordance with Alere's employee manual
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations

• Follow up on insurance claims
• Appealing denials to get insurance claims paid
• Working accounts receivable to get unpaid accounts up to date
• Verifying insurance
• Updating patients accounts
• Taking payments from patient
• Collecting on past due patient accounts
• Processing third party claims
• Processing claims electronically and mailing claims
• Utilizing Availity to check claims
• Adjusting claims
• Obtains Authorizations for claims to be processed through CareCentrix system.
• Other Systems used: CDS, Facets,

• Learning the procedures of coding and billing different entities
• Insurance Billing procedures, Insurance claims processing, CMS 1500 claim forms, HMO, PPO, POS
• EOB's, Rebills, Processing Appeals, submitting claims electronically.

• Accurately apply credits and update customer accounts
• Answer phones, and help consumers efficiently manage and optimize their accounts
• Monitor accounts for routine adjustments and updates
• Follow client specific policies when processing documentation
• Investigate customer financial status when delinquent on payments
• Submit monthly reports of accounts worked will collections notes to management.

• Prescription Drug Plans / Call Center, Managed incoming calls from clients in regards to prescription drug plans
• Processed claims and payments and researched and finalized claim submissions
• Adhered to strict HIPAA regulations; familiar with drugs and drug terminology.