Claims Representative Home Infusion
Resume:
Terri J Nice
Milford, Ohio, 45150
Phone number 513-***-****
Cell number 513-***-****
Work Experience
Tri Health 11/2022 to Feb 2023
Claims Variance Speicialist- Working with Epic I would go through the work queue and find claims that were trending with the same reason for denial. It was either, it was registered wrong, or it needed adjustment with a small balane adjustment or it was reversing a claims override.
CHI- Common Spirit 12/2016 to 11/2022
Reenue Cycle Co Ordinator. I worked physicians claims for home infusion for Anthem, Humana, United Healthcare and Medicare part D. I worked the claim from beginning to end calling the payers to get information as to why the claim denied, what particular code or codes. I would then send in a reconsideration and it that was denied also I would send in an appeal . If that did not work then I would call back and speak to a supervisor to try to get the claim paid.
Anthem 12/2005 to 07/2016
Claims Representative Dental/ Health III- I processed claims for Medical Advantagve for facility and professional claims. I also processed ambulance claims using the facets software. These claims that were manually touched were from the queue where the virital processor could not proess and was getting a denial. Usually these claims were denied because of the wrong provider id that was entered into our system.
Education
Little Miami High School Graduated 1980. General studies
Southwester college Graduated 2006
I studied Medical Coding and Billing. I graduated Suma Cum Lauda with a diploma
References
Susan Smith - 513-***-****
Karen Bilert – 937-***-****
Jeannie Wesley 513-625-221
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