Sary Perez

Responsible for Plan Direct Care Audits.

Responsible for Facets Medicare Advantage Audits.

Check for errors on medical claims, fix error, report error.

Knowledge on QNXT and FACETS computer system.

Responsible for IDN's and EOP's.

Responsible for Plan Directed Care audits.

Responsible for Facets Medicare Advantage Audits.

Check for errors on medical claims, fix errors, report errors.

Knowledge of QNXT and FACETS computer system.

Responsible for IDN's and EOP's.

• Analyzed complex claims to determine validity and ensure compliance with policy guidelines.
• Managed claim investigations, collaborating with internal teams to gather necessary documentation.
• Mentored junior staff on best practices for claims processing and resolution strategies.
• Implemented process improvements that enhanced efficiency in claims handling workflows.
• Developed training materials for new hires, focusing on regulatory compliance and system usage.