Follow-Up Physical Therapy

Margaret Tanner

**** ***** ***** ******, ********* P

Indianapolis, IN 46254

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Denials/Appeal Writer

Conifer Health Solutions

April 22, 2024-Current

• Analyze payor Contracts for contractual reimbursement rates, obligations and methodology used to pay claims.

• Review EOB CARCS and RARCS to see why claim denied.

• Identify coding errors, and missing information on claims.

• Write appeals to upload to payor portal or mail.

• Send supporting documents via payor portal or mail.

• Follow-up with phone calls as needed to payors on written appeals.

• Check status on payor portal or upload needed documents.

• Send corrected claims when needed.

Denial Specialist

Hopebridge LLC

August 2020- February 9, 2024

• Investigate Denied Claims for ABA Therapy, OT/PT/SP for Autism

• Effective communication

Works well with a Cross functional Teams

• Ability to Problem Solve Issues

• Check insurance payment for accuracy and compliance with contract.

• Upload documents on Payor portal including Filing appeals.

• Identify and bill secondary and tertiary payors and apply balances to patient accounts when appropriate.

• Review allowed amount against Fee Schedule/Contract

• Notify Posting Department of Any unpaid claims by submitting Remit • Maintain constant follow-up on unpaid claims with Payor

• Investigate Rejections, Correct and Refile Claim

• Demonstrate positive interactions with payors, teammates and patient families AR Specialist

Zotec Partners

April 2017-June 30, 2020

• Resolve Coding Issues

• Denial management, follow-up, rejections, rebilling, collections

• Resolve issues with Insurance Companies

• Resolve issues with Patients.

• Use different software to complete assignments.

AR Specialist

Surgical Care Affiliates

August 2014 -March 2017

• Submit medical claims, electronic, paper and fax.

• Denial management, follow-up analysis, rejections, rebilling, collections

• Insurance follow-up, write appeals, redetermination, reconsideration administrative law judge

• Patient inquiries, patient statements, update patient demographics

• Prepare revenue reports and AR reports.

• Collection Agency reporting

• Process patient refunds and insurance refunds.

• Submit Coding corrections.

Insurance Verification Specialist

ATI Physical Therapy/Methodist Sports Medicine

October 2009 -July 2014

• Contact Insurance Companies daily to verify primary, secondary insurance and DME coverage for in-network and out-of-network physical therapy benefit coverage Obtain initial prior authorization/precertification as required by insurance plan.

• Document clear and concise information in computer system to complete verification process.

• Ability to work in a demanding environment with emphasis on quality assurance.

• Maintain friendly cordial relations with clients and employees to produce a positive work relationship with customers, co-workers, patients and manager

• Daily input of charge entry billing for physical therapy services

• Maintain and fax daily reports to adjusters, case managers and employers for workers’ compensation patients. Obtain additional authorizations as needed for services Took Inbound/outbound calls from pregnant members in the Healthy First Steps Program

• Processed provider referral faxes for member enrollment

• Performed clinical risk assessment

• Performed eligibility checks on all Medicaid members

• Computed risk factors using United Healthcare new score tool

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