Pamela Allen

Reviewed rejected or denied claims for incorrect authorization, patient eligibility, coordination of benefits, payor payments, patient information and coding errors. Reviewed CMS 1500 0

PB UB04 HCFA FACILITY Claims. Reviewed insurance plan EOP EOB RA for explanation of claims payments patient benefits and plan adjudication. Performed claim correction and edits. Performed corrected claim edits for claim paper or EDI resubmission. Reviewed claims and patient accounts for payor over payments, under payments, offsets and take backs. Reviewed and prepared and processed appeals and grievances for plan adjudication and payment . Performed patient account resolution. Reviewed claims against CMS guidelines for correct pricing coding payments. Use of DRG for length of IP stay and services pricing. Reviewed and corrected for correct insurance payor and coordination of benefits primary and 2ndary payment.

Worked with EMR EHR CRM AVAYA Payment Processing systems. EPIC (all areas) GE IDX MYSYS Centricity ORCA Oracle Cerner VA DEERS Tricare Triwest Cerner Citrix CareRadius IBM PGBA Optum Rx Express Scripts CVS Caremark PBMs MS 360 Centamax and MS Office Suite Facsys medical management software programs. Use Skype for Business Teams Zoom Google Connect for inner office communications, meetings, collaboration, and training. Use of knowledge of CPT HCPCS HCFA ICD 10 NDC codes for claims review and corrections. Use of insurance portals websites and applications for verification of eligibility benefits coverage and COB. Use of Provider One, Optum UHC Link, Availity, One Healthport. CVS Aetna KHP PBC RBS CMS NORIDIAN TRICARE PRIME USFHP Triwest and Change HealthCare portals. Use of knowledge of medical terminology translation transcription and document selection to prepare and submit for appeals grievances and reconsideration for correct payor payments

• Patient registration
• Patient check in
• Patient Appointment Scheduling
• Insurance eligibility benefits coverage verification
• Referrals Authorizations processing
• Enrollment Coordinator
• Patient Care Services Coordination
• Reviewed rejected or denied claims for incorrect authorization, patient eligibility, coordination of benefits, payor payments, patient information and coding errors.