Taking inbound calls to provide member/patient with information about the claims. Explaining the benefits of the patient, copayment, deductible and coinsurance

Achievements/Tasks Communicating with insurances and beneficiaries. Doing outbound calls for the denial of the claim. Determine how to overturn each denial, creating appeal letter and checking the status of the appeal. Sending Coordination of benefits letter to pat

Recommend, implement, and monitor preventative and corrective actions to ensure that quality assurance is achieved. Compile and analyze statistical data. Conducting Weekly error and trends discussion. And conducting Bi-weekly QA scores update with onshore team.

Serve as the team member on point to analyze, review, update and route IP, OP and ED accounts to the appropriate coding workflow. Obtain missing documentation and/or escalate to if not resolved or addressed immediately.