Tammy Marsden

Informs Medicare beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program.

· Assists with the review process to maintain required timeliness and accuracy as stipulated by contract and the QIO manual.

· Acts as a neutral liaison for beneficiaries, their families and/or their representatives.

· Informs Medicare beneficiaries, healthcare providers, and other partners of the activities and responsibilities of the Quality Improvement Organization

· Develops and maintains positive relationships with external and internal customers.

· Prepares correspondence to physicians, facilities, and other healthcare and community organizations as needed.

· Ascertains the most current and correct contact information, maintains accurate mailing lists and coordinates mailings.

· Responsible for complete medical record processing and maintenance.

· Tracks all telephone calls and essential components of conversations, and letters mailed to beneficiaries and providers using an electronic web based application.

· Enters data into software applications timely and accurately.

· Participates in the continuous improvement process to identify quality issues and recommends solutions.

· Assists in preparation for International Standardization Organization (ISO) audits.

· Protects the confidentiality of beneficiary information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH).

· Attends annual security awareness training and testing, rules of conduct and conflict of interest training.

· Performs other duties as assigned

Made contact with insurance carriers to discuss their policies and individual patient
benefits.
Assured the timely verification of insurance benefits prior to patient procedures or
appointments.
Observed strict procedures to protect sensitive patient information, including medical
records and payment data.
Accurately inputted all patient and insurance information into the company's computer
system using Touchstone.
Maintained a strong knowledge of basic medical terminology to better understand services
and procedures.
Prepared insurance claims for submission to clearinghouses or insurance companies.
Obtained prior authorization and referrals for outpatient procedures.
Obtained data such as patient, insurance ID, insurance provider and medical codes to
properly file insurance claims.
Verified insurance and communicated coverage to staff and patients.

• Strengthened client relationships through consistent follow-ups, ensuring timely renewals and retention.
• Reduced claims processing time by effectively collaborating with adjusters, claimants, and internal departments.
• Streamlined policy management by regularly updating client information and tracking policy changes.
• Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.