Navigant Cymetrix, Lewisville TX
Revenue Cycle Third Party Payer
Patient Account Representative
Review accounts, obtains claims status, receives and review denials, taking in-coming and making out-going calls to patients and insurance company to resolve account balances to zero. Mail correspondence to patient for COB information.
Update patient demographic and initiate account adjustment in Meditech and Metrix. Verify insurance eligibility and coverage, and process accordingly. Request Medical records for appeals, resubmit claims to insurance company.
Amazon Haslet, TX
Package Handler Fulfillment Center
Work in dock, doing small package handler
TrailBlazer Health Enterprises, LLC Dallas,TX
Part A Claims Processor
Claims processor: Reviewed CWF workload assignments, daily pending. Process Part A hospital claims according to internal instruction. Completed data corrections for all assigned reason codes. Monitored claims to ensure timely processing.
Utilization location –process claims according to benefit days remaining. Medicare 60-30-60. Reports L1001 & Trailer 15 - CWF has accepted the Inpatient deductible out of sequence. Adjust claims to remove cash deductible. L1002, & Trailer 20 -CMS have accepted an out of sequence Inpatient or SNF claims linking two benefit periods.
Adjust claim back to CWF in date order, according to benefit days remaining.
Skilled Nursing Facilities (SNF) Denial of Payment for New Admission (DPNA). To ensure any monies paid by Medicare Program are recouped when CMS indicates the provider is non-compliant for participation.
Data Entry: Entered hospital claims (UB04) in the Fiscal Intermediary Standard System (FISS) for processing. Reviewed errors and made corrections. Processed RTP’s (Return to Provider), adjustments and canceled claims.
Activate an internal batch, to correct if any reason codes required an adjustment or to cancel a claim. Follow up on adjustment to verify that it finalizes correctly.
Reason code U5601- inpatient or skilled nursing facility dates of services overlapping a previously paid claim. Order medical records- Additional Development Request (ADR). Reviewed medical records to determine any overlap. Made corrections if the provider has sent corrected UB04. If records are correct for our dates of services. Sent requests for Assistance letters to other contractors to verify claim billed. Followed up in CWF if other contractor claim had been, adjusted or cancelled. Release our claim for processing.
Data Entry Clerk
Data Entry Clerk - Data Entry Department
Keyed claims (UB92) in the Medicare system. Meet production and accuracy requirements.
Determine appropriate resolution and execute corrective action or RTP.
Development Department Clerk Typist
Compiled a form letters for beneficiaries with Railroad Retirement and attach their claims.
Mail letters and claims to Railroad Retirement.
Microsoft Office, Extensive claims processing experience, Data entry experience (10,000 ksph)
Medicare Part A Claims, Medicare Direct Data Entry System (DDE), Fiscal Intermediary Standard System (FISS),
Health Insurance Master Record (HIMR)Common Working File (CWF)