Tamara Lara

• Reviews and resolves accounts assigned via work lists daily as directed by management. Focus on working complex denials across multiple payers and/or regions. Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice.
• Conducts follow up research on claims to review contract discrepancy and account balances. This may include attaching documentation, amending coverage/patient/encounter/provider/facility data, gathering additional information requests, and resubmitting corrected claims to ensure accurate and timely claim adjudication. Review explanation of benefits (EOB) or, if not present, call the Payor to obtain claims status for denied claims
• Defends and appeals denied claims, including researching underlying root cause, collecting required information or documents, adjusting the account as necessary, resubmitting claims, and all appropriate follow up activities thereafter to ensure adjudication of the claim. Must also be comfortable communicating denial root cause and resolution to leadership as needed.
• Maintains an up to date knowledge of department policies and procedures; responsible for external changes made based off future state revisions to processes.
• Performs other duties as assigned by management, included by not limited to training new staff, projects given from management as well as director.

• Secure patient demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation
• Works change of location and level of care reports daily, maintains established goals, and notifies Manager of issues preventing achievement of department goals. Assists each agency with patient concerns/questions to ensure prompt and accurate resolution is achieved when billing.
• Negotiate with insurances to resolve any known problems to help reduce AR by making phone calls, sending disputes and/or appeals to help get claims paid within a timely manner.
• Enter Physician charges via Homecare Homebase system to then enter manually in Palmetto system and other clear-houses for Medicare, Medicaid or Commercial insurances for processing.
• Enter NOE submissions for Medicare patients in Palmetto system to then be validated correctly.
• Develop and implement prior authorization work flow, policies and procedures
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
• Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
• Trained new workers regarding Homecare Homebase System as well as any new updates with Palmetto system.

• Handles special projects as assigned by leadership. Documents billings, follow-up and/or collection steps that are taken and all measures to resolve assigned accounts, including escalations from Managements
• Works follow up report daily, maintains established goals, and notifies Manager of issues preventing achievement of department goals. Follows up on daily correspondence (denials, underpayments) to appropriately work Patient accounts.
• Educates team of inconsistencies in processes with varies payers.
• Negotiate with insurance to resolve any known problems to help reduce AR by making phone calls, sending disputes and/or appeals to help get claims paid.
• Research and analyze claim denials in accordance to contract with Hospital and varies insurances. Therefore, tracking and analyzing trends which are causing these denials.
• Works with Insurance payers to ensure proper reimbursement on patient accounts. Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report to expedite resolution of accounts.
• Monitors and assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by Manager. Trains new staff, performs audits of work performed, and communicates progress to appropriate Supervisor. Provides continuing education of all team members on process and A/R requirements.

• Demonstrates values and behaviors consistent with our culture
• Come up with, revise and present design ideas with assistant merchandiser.
• Oversee the production and brief employees on arranging displays.
• Engage in genuine conversation while completing cash-wrap transaction processes quickly and accurately
• Interpreted company policies to workers and enforced safety regulations.
• Suggested changes in working conditions and use of equipment to increase efficiency of shop, department, and work crew.
• Analyzed and resolved work problems and assisted workers in solving work problems.
• Successfully managed a 7-person team in running a retail operation.
• Trained new workers.
• Conferred with other supervisors to coordinate activities of individual departments.
• Responsible for opening/closing of the store, bank deposits, paperwork, and unloading of truck.
• Performed activities of the workers supervised, when needed.