MIKESHA BLOCKER

Key Responsibilities

• Verify that MDE requests are in line with DBQs

• Review MDE reports and DBQs to ensure they are accurate, complete, and do not have any typos or grammar mistakes.

• Communicate with medical providers and assist in any corrections required to MDE reports or DBQs before submission to VA.

• Confirm that the VA requirements address all specific requests and any necessary secondary evaluations.

• Document and submit all diagnostic tests requested by the medical provider and ensure the results that are input into the DBQ are accurateConduct daily queue maintenance to verify that each assigned case contains updated notes and that all necessary actions have been executed.

• Contact the Medical Advisory Board regarding cases that require further evaluation, which may fall beyond the expertise of the assigned medical provider, or may have encountered challenges with the designated medical provider.

• Continuously meet production targets.

• Answered questions regarding the flow of work through the various systems of Insurance Operations
• Supported the Insurance Ops team by identifying issues and presenting resolutions
• Took ownership of monitoring, tracking, and statusing the health of all work in progress issues
• Managed the escalation and resolution process with external vendors to ensure appropriate turnaround times
• Contributed to teamwide goals to improve processes and integrate additional functions into our daily operations.

• Communicated clearly in person and on the phone to establish/maintain cooperative relationships with patients, families, physicians, staff, and management
• Provided necessary forms to patients for completion and signature
• Reviewed all forms for completeness and accuracy
• Verified patient's pharmacy insurance eligibility
• Effectively utilized the EMR, as well as, online authorization sites for medication programs
• Copied, faxed, and mailed documents and information as requested by insurance carrier
• Established and maintained effective working relationships with patients, providers, team members, insurance companies, and the public
• Fulfilled organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient's rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
• Provided safe patient-centered, compassionate, and competent care
• Ability to interact with diverse groups
• Required to attend all scheduled monthly meetings.

• Filled prescriptions and checked for expiration dates on medications
• Entered and maintained prescription data using computer system
• Answered incoming phone calls and fielded patient questions
• Assisted the pharmacist with maintaining the ongoing medication inventory and placed medication orders when instructed.

• Updated and managed diagnosis lists, coordinated routine documentation and coding audits, and executed qualitative analysis of discharge charges
• Revised CPT codes and ICD-10 codes before submitting to insurance for chiropractic services and durable medical equipment
• Entered charges for surgery and anesthesia billing and provided patients cost consultations, payment plans, and answered insurance questions
• Assigned codes on all diagnosis, procedures, and supplies with descriptive ICD-9 and HCPCS codes for all patient encounters for reimbursement
• Discussed physicians' choice of E/M level when in question
• Audited level of E/M and coded outpatient procedures and applied DX codes
• Submitted insurance claims, edited billing lists, edited diagnosis codes, edited HCPCS codes
• Stayed up to date and educated others on ICD, HCPCS, and LCD guidelines/updates
• Verified insurance, billing, payments, posting charges, coding ICD-10, and claims processing
• Documented detailed notes on each account work every time it is worked to collect outstanding A/R.

• Answered customer inquiries and provided accurate information regarding products and services.
• Provided excellent customer service to resolve customer complaints in a timely manner.
• Resolved complex problems by working with other departments to provide solutions that meet customer needs.
• Identified areas of improvement in customer service processes and suggested changes accordingly.
• Developed strong relationships with customers by providing personalized assistance and support.
• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
• Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
• Remained calm and professional in stressful circumstances and effectively diffused tense situations.
• Answered inbound calls, chats and emails to facilitate customer service.
• Used approved scripts to de-escalate angry customers during telephone interactions.