ODELINE NERETTE

• Reviewed customer claims, identified discrepancies and determined appropriate course of action.
• Conducted investigations to gather evidence in support of claims resolution.
• Assessed medical records for coverage eligibility and benefit accuracy.

• All patient related accounts receivable balances including Medicare, Medicaid, Insurance, Private and Other Payers to ensure accurate balances, timely billing and collections.

• Ensures accounts payable invoices are processed accurately and timely

• Responsible for back end collections balances due from residents after discharge.

• Responsible for back end collections of A/R balances due from residents after discharge

• Manage the Medicaid application process, including submitting LOC

• Reviewed patient records and verified insurance eligibility.
• Researched providers to determine if they are in-network or out-of-network for the patient's health plan.
• Coordinated referrals with primary care physicians, specialists, and other healthcare providers.

• Maintains and completes diary on cases submitted to CMS and other files with legal/technical issues.
  • Manages Client Profiles/Allegro screens as necessary (case specifics, CMS Tab, Initial CMS Approval, CMS Discrepancy and client resolution)
  • Processes all mail related to cases submitted to CMS including requests for additional information (30 & 14 day letters).
  • Processes all mail (CMS Approvals) related to cases where CMS has approved a counter high or counter low allocation. Completes review of the file to identify major discrepancy points. Prepares correspondence to client documenting CMS approved MSA amount.
  • Reviews and prepares portions of the CMS submission.
  • Reviews settlement documents and other pertinent file materials for proper submission to CMS.