Victoria Holden

* Customer service representative - addressing calls and

in person interactions with patients regarding their

balance concerns, denials, adding insurance information,

processing payments, assisting patient in obtaining

eligibility in state Medicaid programs, and any other

concerns patient might have. Expedited resolution of

account discrepancies by maintaining open

communication with patients, providers, and

insurance companies.

* Bad debit work queues - responsible to address each

account to verify insurance eligibility to minimize claim

denials and ensure accurate reimbursements. Ensure

timely filing of claims through efficient management of

work queue and prioritization of tasks. Look for any

state Medicaid eligibility to assist patient with

financial help with outstanding balances.

* Failed Mail Return work queue - responsible to research

returned mail for new updated addresses with use of

current insurance information, or use of Experian for

address search. If new insurance information found,

verified eligibility, then billed eligible dates of service.

* Medicaid Scrub work queue - responsible to look for

enrollment in Medicaid, verify eligibility and bill eligible

dates of service. Any dates of service not eligible to be

billed, but had active Medicaid, was responsible to

write off balance to Medically Indigent Charity Care.

* Agency 53 - accounts returned from bad debit was

responsible to look for Medicaid, verify if currently active,

and if so, then write off balances as Medically Indigent

Charity Care to prevent accounts from going to Legal

Department.

* 954 Billing Indicator - accounts found in Epic to have

other primary payor then we were previously billing.

Verified the primary payor found was eligible, added

the correct primary payor and billed.

* Responsible to underwrite individual applications with use of

medical records and labs to determine eligibility for enrollment

in individual/family medical insurance plans.

* Responsible to handle Supervisor complaint calls and

address them with favorable outcomes.

*Received calls from physicians in regards to what medical

information would be required to have patient

reconsidered for insurance coverage.

*.Trained several classes of Underwriters.

* Audited entire unit of Underwriters for the Supervisors

- responsible to address any problem areas found within

the audits with possible need for re-training.

* Worked with Legal Department regarding need for

retro-cancellation of policies, if approved then responsible

to address justification of decision in a letter. Handled

complaints made to the Department of Insurance, Department

of Corporations and Attorney General's office by investigating

the complaint and addressing in a letter our conclusion and

how we came to it, if error was done, then I was responsible

to make all necessary corrections to their satisfaction.