Hilary Rachel Means

*** **** ****** ****, *** *09, Philadelphia, PA 19144

Phone: 267-***-****, E-mail acd5pn@r.postjobfree.com

Experience

AMERIHEALTH ADMINISTRATORS Fort Washington, PA

Precertification Specialist 07/11 to present

Responsible for screening incoming calls and

facsimiles from both members and providers to

initiate the certification process.

Gathers demographic information and create case

files in the certification software process.

Responsible for conducting scripted reviews on

maternity, inpatient and outpatient cases per

departmental procedures as approved by state or

national accreditation agencies. Certifies requests

based on the departmental policies or refers to the

Patient Care Coordinator or Case Manager for review.

Responsible for making outbound calls to providers

or facilities requesting needed information to

complete the precertification process or to obtain

the appropriate discharge information.

Refers cases to the external URO vendors when

necessary.

Data entry is used to create internal case files

that have been certified by contracted certification

vendors

Also triage inquiries that have been received via

queue, fax server or phone call regarding medical

management issues.

AMERIHEALTH ADMINISTRATORS - Fort Washington, PA

10/06 to 07/11

Senior Claims Examiner

Handled all claims and documentation for members and providers in a timely

and accurate manner. Analyzed and understand the coverage provided under a

member's plan. Utilized multiple systems to obtain and record claim

information, data entry and to make claim payment decisions.

Other duties include processing of Coordination of Benefits claims, ensuring

the use of the proper codes and submission of all needed information to

process claims per established benefits.

GENEX SERVICES, INC. - WAYNE, PA

09/04 to 10/06

Medical Cost Analyst

Added individual providers, groups and hospitals to main database. Analyzed,

reviewed and keyed in health care provider claims. Reviewed bills for correct

coding and proper billing by the provider. Ensured correct application of

Workers' Compensation state fee schedules and usual and customary charges.

Resolved and checked bills that are scanned into the medical billing tracking

system. Communicated with providers to obtain information missing on the

bills. Ensured that physician notes and invoices for durable medical

equipment are attached. Used the Case Management System to check if physical

therapy, chiropractic and MRT visits had been pre-certified/approved/denied.

AHP SETTLEMENT TRUST - Philadelphia, PA 09/02 to 09/04

Claims Processor/Auditor

Added individual providers and hospitals to main database. Analyzed, reviewed

and keyed in health care provider claims. Checked claims for correct CPT

codes dates of service and checked to ensure the correct tax id number and

provider are selected. Ensured that the correct components are included in

the claim packet for processing.

Duties also included phoning and faxing healthcare providers to obtain any

components that are missing from the claim packets and completing special

projects as assigned.

CONCENTRA MANAGED CARE - King of Prussia, PA 06/00 to 09/02

Regional File Maintenance Clerk/Data Entry Analyst

Analyzed, reviewed and keyed in health care provider claims. Added providers,

hospitals and claimants to main database and ensured that they are linked to

the correct group.

Checked the claims for correct CPT, NDC and other necessary processing codes.

Ensured that physician notes and invoices, if needed, are attached. Performed

audit responsibilities for provider and hospital claims.

SUMMARY OF SKILLS

1. Computer and Data Entry Skills

2. Customer Service experience

3. Knowledgeable in various managerial procedures.

EDUCATION

1. Peirce College - Philadelphia, PA - Associate's Degree of Science,

major in Health Information Technology. Expected graduation date: 2016

Contact this candidate