TANYA ALBURY

Serve as a Subject Matter Expert (SME) to support team members.

Collaborate with hospitals, clinics, and clinical teams to manage service requests.

Initiate and terminate services for ALF, Home Health, Hospice, Home Delivery Meals, Consumable Supplies, and Adult Day Care for members.

• Resolved any discrepancies with the Case Managers regarding Assignments to ensure services are initiated in a timely manner
  
  Manage member intake, admissions, and discharge post-notification.

Handle incoming and outgoing referrals, and prior authorizations.
Resolve inquiries and identified the members ne from members and healthcare providers efficiently.

Identified the needs of members promptly and efficiently.

• Trained employees on processing Advanced Beneficiary Notices and Workflow Replacement Transmitters.
  
  Ensured all medical documents and patient accounts were consistently updated and complete for shipping and billing accuracy.
• Kept documents moving in proper flow by applying strong organizational, planning and multitasking abilities.
• Identified trends and provided feedback to supervisors on compliant documentation requirements for services provided.
• Verified accuracy and integrity of supplied data against established standards.
• Promptly responded to requests for information while maintaining security.
• Inspected and proofread documents to check accuracy.
• Audited supply configurations based on physician authorization.

Reviewed and approved clinical notes for Durable Medical Equipment (DME) orders, including insulin pumps, and glucose monitoring systems.

Analyzed insurance requirements to ensure guidelines were met before processing orders.

Researched and resolved issues on the Unbilled List, addressing problems such as invalid start dates, expired orders, missing HCPC codes, and more.

Prepared Cancel/Claim Adjustment Forms for appropriate supply write-offs, while adhering to established guidelines.

Maintained compliance with Medicare, Medicaid, HIPAA, and private insurance regulations.