Nancy C. Draper
Carthage
Summary
Professional with comprehensive experience in claims processing and evaluation. Demonstrates strong analytical skills, thorough knowledge of insurance policies, and consistent track record of identifying and resolving complex claims. Valued team player with strong focus on collaboration and results, adaptable to evolving work environments. Known for reliability, problem-solving abilities, and effective communication with stakeholders.
Overview
6
6
years of professional experience
Work History
Claims Examiner
Office of the Staff Judge Advocate, Claims Division
Fort Drum, NY, United States
01.2021
- I am the current Claims Examiner at the Office of the Staff Judge Advocate. I handle both Medical Affirmative Claims and Tort Claims for the United States Government. I review, analyze, and investigate Medical Malpractice, Automobile, and personal injury claims brought against the United States Government. AR 27-20, Claims Manual, which dictates if a denial or payment for the claim will be issued to the claimant.
- I am responsible for all customer service aspects in my position. I plan meetings with my claimants, help them prepare their Standard Form 95, and answer all questions about their claim. I am responsible for preparing all communication to claimants, law offices, insurance companies, hospitals and other OSA offices to include those overseas. I develop a relationship with the claimants and become their liaison through the whole claims process. I manage any complaints or concerns the claimants have throughout the claims process.
- I prepare written recommendation stating the facts on the claims after investigating. These recommendations to the attorneys help decide if the claims meet the criteria for approving or denying them under AR 27-20. I maintain individual records, both digital and hard copy for each claimant. All files are kept in ACMIP and all data collected is uploaded and maintained as the claim progresses. I maintain accountability for all equipment associated with the claim’s investigation. I collect evidence and upload the evidence into the correct database.
- Claims that I investigate take me to all walks of life on and off base. Whether it is the backwoods of the range or a paved parking lot, I am prepared and ready to pull my sleeves up and investigate.
- I maintain a professional relationship with the attorneys in the Legal Assistance Office, Military Justice, and Administrative & Civil Office. I lean on these colleagues for assistance with their expertise in their field when I have questions regarding the claims filed.
- I am responsible for quarterly and fiscal year reports on claim status, as well as monetary value of what was paid out from the claims office and what was reimbursed to the United States Government in pursuant of Medical Affirmative Claims under the Federal Medical Recovery Act.
- I prepare liens for all medical costs owed to the United States Government. This includes researching medical records for injury and accidents that are reimbursable by a third-party payer to the United States Government. I am responsible for the denials and rebuttals to the insurance companies when payment is owed to the United States Government. I work with the Claims Attorney assisting with compromising on the liens as well as waivers of liens. This includes working with law offices and negotiating for a responsible solution for the patient.
- I am responsible for payment preparation for the claimants. This entails utilizing Ask DFAS for Vendor ID’s & The General Fund Enterprise Business System, known as GFEBS. I submit for payment using T-codes. FB60 is the main process code I use currently along with FB08, FB03 &FB02. In past employment I have utilized the FB50. If the claims are over a certain dollar amount, I utilize the Judgement Internet Claims System to process payments.
- Supervisor: Shawn Graham, OSA Claims Attorney / Acting Chief of Legal Assistance 772-2892 or cell (917) 579-1290 Yes, please contact for reference
- Pay Grade: GS-09, 0998
- Hours Per Week: 40, with a RDO every other Wednesday
Supervisor
Uniform Billing Office and Claims Examiner
Fort Drum, NY, United States
05.2014 - 04.2020
- I served as Supervisor of Uniform Billing Office and Claims Examiner. As the UBO Supervisor and Claims Examiner, solve difficult and complex problems in the areas of the Third-Party Collection Program (TPCP), Medical Services Account (MSA) and Medical Affirmative Claims (MAC) Programs. I am a delegated authority for certifying, approving and dispositioning of the TPCP, MSA and MAC programs.
- I serve as the supervisor for all elements of the Medical Treatment Facility (MTF) Uniform Business Office including Third Party Collection Program (TPCP), Medical Service Account (MSA), Medical Affirmative Claims (MAC), Army Billing and Collection Utilization Solution (ABACUS) and Other Health Insurance (OHI). I am responsible for processing and recovering claims against the government, costs to Guthrie AHC incurred by retirees and military dependents. I conduct analysis of the medical claims/billing process and recommend, develop and implementing procedures to improve efficiency and enhance/maximize collection of these claims. I directly monitor activities related to the third-party collection process, including but not limited to, International Classification of Diseases (ICD)-9 and 10/Current Procedural Terminology (CPT)-4 coding.
- I am responsible for establishing long and short-range goals and objectives for the TPC/MSA Programs in keeping with the MTF mission and evaluating performance against those objectives. I ensure the operation of an effective system of internal controls by periodically reviewing internal control measures and initiating needed revisions, and by conducting vulnerability assessments on an annual basis. Assure that patients have an approved health care plan at the time services were rendered, frequently requesting verification of same.
- I ensure the completion of insurance forms. I examine the information collected to determine the validity of submitting the insurance claim verifying diagnosis in medical records and, when pertinent information is not furnished, consult with professional staff. Responding to numerous telephonic and written inquiries from insurance company representatives, employees, and veterans pertaining to various cost recovery requirements and policies and procedures regarding release of information and billing. I make sure compliance is met with requests for medical information released from a variety of sources in accordance with the Health Insurance Portability and Accountability Act (HIPPA).
- I perform the 2570 Quarterly Metric report. The report reflects amounts billed, waived, disapproved and collected. Responsible for compiling and summarizing statistical data for appropriate staff on change of insurance carriers, regulations, policies and procedures. Process payments received by pulling billing invoices for verification purposes, making appropriate annotations and submitting them to the Resource Management Division (RMD). I am a member of the data Quality Team and report the OHI compliance for the MTF and the outlying clinics to RMD. When not meeting the 97% compliance goal, I am required to investigate and find solutions to meet compliance once again.
- I manage the MTF Medical Services Account (MSA) and Medical Affirmative Claim (MAC). I serve as manager for the Health Center MSA and MAC sections, which include collecting, reporting, depositing funds and billing operations for authorized and unauthorized services received. Establish and convey goals and priorities, interpret regulatory requirements and provide guidance and direction to subordinates. Research and prepare billing documents for Department of the Army agencies that receive outpatient services. I perform accounting techniques, ensuring the monies are accurately accounted for. I endorse and deposits checks received for outpatient services. I ensure ledgers are reconciled and submit all required reports by the designated deadlines and forward them to the appropriate agency. I resolve questions concerning eligibility for care and applicable charges. I coordinate with MTF RMD and Defense Finance and Accounting Services (DFAS).
- Responsible for facilitating coordination between the Staff Judge Advocate Medical Claims Recovery Clerk. Oversee that the Medical Claim Affirmative Program at the MTF to ensure claims are identified in favor of the government for reimbursement of funds for third party liability accidents. Ensure claims are prepared in proper format to ensure payment will be received. Ensure that all Army Regulations (AR 5-9 & AR 27-20) are followed to preclude any claims will be rejected. Oversee the Memorandum of Agreement (MOA) between Staff Judge Advocate Office and the Military Treatment Facility. Ensure that this MOA is updated on an annual basis as well as the agreement is satisfactory with both parties and processing of claims follows this MOA. Identify, prepare and submit the claims to the Staff Judge Advocate Office for assertion. Preparation of the claims requires telephone conversations, conducting interviews and contacting insurance companies to validate that the accident claim is valid. Once claim has been processed by the Staff Judge Advocate and funds are received, the Staff Judge Advocate provides funds to me to ensure they are properly processed in the correct line of accounting.
- Guthrie AHC, Fort Drum, NY United States
- Supervisor: MAJ Molly Burns – 315-772-4316; Contact: Yes
- Pay Grade: GS-0998-08
- Salary: $50,392.00
- Hours Per Week: 40 Hours
- Uniform Billing Office (UBO)
Education
High School Diploma -
Carthage Central High Schoola
Carthage, NY06-1993
Skills
- Written and verbal communication - explaining decisions, requirements, procedures, and technical information clearly
- Attention to detail - reviewing documents, equipment information, records, and other evidence accurately
- Decision-making - using judgment and initiative to determine appropriate solutions
- Organization - maintaining records, planning work, and managing competing priorities
- Time management - handling cases or support requests efficiently and meeting deadlines
- Multitasking - managing several claims, customer inquiries, or technical issues simultaneously
- Interpersonal skills - working tactfully and professionally with people at different levels
- Computer proficiency - using Microsoft Office, data-entry systems, and specialized business software
- Documentation and reporting - recording findings, actions, decisions, and outcomes
- Policy and procedure compliance - following company standards, regulations, and established processes
- Independent work - taking initiative while knowing when to involve specialists or management
- Team collaboration - coordinating with customers, sales staff, medical or legal professionals, and other stakeholders
Timeline
Claims Examiner
Office of the Staff Judge Advocate, Claims Division
01.2021
Supervisor
Uniform Billing Office and Claims Examiner
05.2014 - 04.2020
High School Diploma -
Carthage Central High Schoola