Manager Medicare Part B/Pharmacy LTC/Medicaid DME claim billing

Misty Womack

Manager Medical Claim Analyst/Adjudicator

Driving license TE610050

Manager Medical Claim Analyst/Adjudicator with extensive 28-year track 4050 Marianne Dr, Dayton, US, 45404

record in Medicaid DME supply claims adjudication across multiple

: . : 1-937-***-****

states. Expert in leveraging data analytics for process enhancements and

maintaining rigorous compliance with Medicare and Medicaid regulations. *********@*****.***

Proven leader in developing training programs that elevate team

performance and optimize claims processes

Employment history

Lead Medicare Part B/Medicaid Adjudicator Sep-20/2'- Present

CVS/Omnicare at Dayton, OH-WFH

+ Managed billing for Medicaid DME supply claims for multiple states

+ Utilized external Medicaid portals for claims submission

+ Specialized in Long Term Care Billing

+ Utilize data analytics tools to identify trends and patterns in Medicare Part B/Medicaid claims processing, and provide

recommendations for process improvements to enhance efficiency and accuracy

+ Develop and maintain relationships with Medicaid and Medicare agencies to stay updated on changes in regulations and policies,

ensuring compliance and maximizing reimbursement opportunities for CVS/Omnicare

+ Implement training programs to educate team members on the latest updates and changes in Medicare Part B and Medicaid

regulations, ensuring compliance and efficiency in claims processing

+ Lead cross-functional teams to streamline the Medicare Part B/Medicaid claims adjudication process, ensuring timely and

accurate processing while maximizing reimbursement opportunities for CVS/Omnicare

+ Collaborate with cross-functional teams to identify opportunities for process improvement and streamline communication

between departments to enhance overall efficiency in Medicare Part B and Medicaid claims adjudication for CVS/Omnicare

* Collaborate with the IT department to identify and implement technological solutions that streamline Medicare Part B/Medicaid

claims adjudication processes, increasing efficiency and accuracy for CVS/Omnicare

+ Learned and managed third party hard copy billing for paper claim billing

+ Negotiating claim window reopening for resubmission for maximum reimbursement

+ Develop and implement quality assurance processes to ensure that Medicare Part B and Medicaid claims are accurately processed

and comply with all regulatory requirements, reducing errors and maximizing reimbursement opportunities for CVS/Omnicare

+ Develop and implement strategies to proactively identify and address potential compliance issues in Medicare Part B/Medicaid

claims processing, ensuring adherence to regulations and minimizing risks for CVS/Omnicare

+ Analyze and assess the impact of upcoming changes in Medicaid and Medicare regulations on claims processing, and provide

recommendations to proactively adjust processes and strategies to maintain compliance and maximize reimbursement

opportunities for CVS/Omnicare

+ Lead the implementation of a continuous improvement culture within the Medicare Part B/Medicaid adjudication team at

CVs/Omnicare, encouraging team members to actively participate in identifying inefficiencies, proposing solutions, and

implementing process enhancements to optimize claims processing efficiency and accuracy

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