Tracey McNair

Processed claims for FSA-HSA flexible spending accounts.

• Reviewed and processed incoming FSA-HSA claims to ensure accuracy and completeness.
• Followed up on pending claims and resolved issues delaying processing.
• Adhered to federal regulations regarding the reimbursement of claims processing.
• Entered claim information accurately into database systems.
• Evaluated the validity of assigned claims by verifying that services are medically necessary according to established guidelines.
• Utilized claims processing software to streamline workflow and increase efficiency.

• Responsible for Medical claims follow up , working with insurance payers to resolve issues and facilitate prompt payments of claims.
• Called Insurance companies to verify coverage and denied claims.
• Researched authorizations, referrals, medical records, and secondary insurance to procure payments. 
• Prepared Appeals, and Reconsiderations. 
• Corrected billing errors and re submitted claims electronically.
• Reviewed EOB's , Provider Contracts for accuracy of payments.

• Maintained Medical claims for Family Practice office.
• Analyzed rejected, denied an unpaid claims in Kareo Billing System.
• Correct any billing errors and resubmit claims.
• Updated patient demographic information, Insurance information in integrated office system Practice Fusion.
• Contacted Insurance Companies to verify coverage, denied claims, and claim status.

• Medical Documentation Reviewer responsible data entry of medical appointments being kept under correct authorization. 
• Contact providers to ensure medical records are sent and documented.
• Reviewed claims for adjudication.
• Sent rejection letters to providers.

• Answered inbound calls answered customers' questions and addressed problems and complaints via phone. 
• Executed outbound calls to existing customers welcoming them to the health plan answering any questions pertaining to their benefits. 
• Adhered to HIPAA compliance.
• Received incoming calls from providers inquiring about claims. Gathered and reviewed rejected claim information in order to successfully process claims.