Sarah Duval

• Ensure timely and accurate submission of claim encounter data to the state, maintaining compliance with regulatory requirements. I support three health plans and have maintained an average of 99.7% accuracy.
• Conduct in-depth reporting, research, and analysis to support data integrity and process improvements.
• Led initiatives to mitigate top recurring data issues, resulting in a more prompt identification of scrub, reject, and exclude errors.
• Collaborate closely with cross-functional teams, including IT to resolve technical issues.
• Deliver presentations to senior leadership to communicate key findings.

Accomplishments

Reorganized the department OneNote by developing comprehensive training and resource guides, including a standardized new hire checklist. Designed and implemented two tracking systems to proactively identify emerging trends and operational challenges.

• Within the claims department, I worked on Nursing Facility claims which are a high priority provider and therefore extremely visible to upper leadership.
• Responsible for a high level of research for claims to ensure payment and denials are valid and priced correctly.
• Research entails reviewing and updating SQL tables, collaboration with internal departments for research and system updates (including UAT), as well as outreach to the state to validate any required updates. Project creation through internal processes and follow through.
• As the most senior member of the team, I was responsible for additional responsibilities including an annual audit from the state, weekly reporting/projects to identify trends, interest review, UAT testing for system updates and Provider/State/Legislative complaints including provider outreach.
• Contact: Keegan Hernandez 737-206-4191

Accomplishments

Created SharePoint site to house Nursing Facility resources and references materials. This resulted in an approximately 15% reduction in time spent looking for departmental resources currently spread out in many different locations.

• Made contact with insurance carriers to discuss individual patient benefits.
• Assured timely verification of insurance benefits and communication to patient prior to appointments.
• Resubmitted claims after adjustments or denial to achieve financial targets and reduce outstanding debt.
• Obtained all necessary authorizations for services.
• Posted payments to accounts and maintained records.
• Contact: Dori Chappell @ dori.chappell@gmail.com