Milledge Ware

Sacramento, CA, *****

Summary:

Milledge Ware is an experienced Worker compensation claims professional with around 10 years of experience in managing workers compensation claims and over all 15 years of experience working in the medical field.

Familiar with reviewing and analyzing medical claims especially with workers compensation,collections, Medi- cal, Medicaid and Medicare accounts utilizing accounts receivable,quality management, and coaching.

Experienced in Quality Management position, which required monitoring agents systems confirming they performed California regulations and guidelines through HIPPA of policy and procedure.

Highly proficient with medical terminology utilizing EPIC software used primarily by large U.S. hospitals and health systems to access, organize, store and share electronic medical records.

Summarizes receivables by maintaining invoice accounts; coordinating monthly transfer to accounts receivable account; verifying totals; preparing report

Excellent verbal and written skills with interpersonal and analytical skills. Skills:

Medical claims,

Worker compensation claims (10 years)

CAMMIS

Dental records.

EMR

EPIC

HIPPA

Customer service.

Medicare, Medicaid accounts.

Time management.

Team player.

Education:

High school Diploma, Far Rockaway High School Sacramento, CA Professional Experience:

Maximus Federal Services, Inc Jul 2019-Nov 2023

Workers Compensation Rep II

Evaluates workers compensation accident reports, ensuring the timely processing of medical bills and temporary total disability benefits;

Reviews medical reports, witness statements, department investigation results and other documentation

Compiles facts and data regarding accident reports and filed cases.

Processed health-based related data in systems

Researched and resolved problems for Workers Compensation claims.

Reported document discrepancies with suggested resolutions to appropriate departments

Communicated with internal staff, and groups as needed to complete processing work

Succinctly summarized the facts of each case and the issues at dispute; designated clinical match of

Ensured correct documents provided to Medical Professional Reviewer.

Researched and determined authority cited to by prior level review organization and performed other duties as assigned by management

Summarizes receivables by maintaining invoice accounts; coordinating monthly transfer to accounts receivable account; verifying totals; preparing report

Used analytical skills to find mutually beneficial solutions to claims and customer issues XEROX LLC/ACS INC Sacramento, CA Sep 2012-Mar 2016 Provider Care Representative

Respond to, handle and resolve provider inquiries about medical claims utilizing and navigating on CAMMIS systems

Provide customers with product and service information

Process, analyze and review orders, forms and applications

Identify and resolve escalated provider/beneficiaries issues navigating through multi- internal systems for assistance

Handle beneficiaries and provider billing issues

Resolve collections by examining customer payment plans, payment history, credit line; coordinating contact with collections department.

Promoted to Quality Management monitoring agent personnel for required navigation of systems regarding company guidelines and regulations utilizing CAMMIS, EPIC, EMR software systems. Access Dental, Sacramento, CA Feb 2011-Jul 2012

Intern/Dental Assistant

Assisted Doctor's, on chairside procedures

Charting, Prophy, X-rays, and Sterilization

Promoting overall safety in an office environment

Reviewed dental records, prepared and arranged dental materials

Assisted the dentist and office staff with billing, patient appointments, and dental laboratory maintenance, etc. Disability Case Management Sacramento, CA Sep 2007-Jan 2011 Utilization Review Coordinator

Handled high volume of incoming telephone calls regarding reviewing and analyzing medical claims- mainly Worker’s Compensation claims.

Covered a range of customer service issues in a prompt and professional manner

Answered customer questions regarding billing/technical problems

Formed a Relations Basis in contacting providers, primary treating, adjusters and litigation department in order to confidentially address continual therapy in regards to Workers Compensation

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