Experience

Petro Truck Stops

• United States
• IT Services and IT Consulting
• 1 - 100 Employee

• Restaurant Cashier

  • Nov 2014 - Present



Novitas Solutions, Inc.

• United States
• Hospitals and Health Care
• 500 - 600 Employee

• Appeals representative

  • Aug 2012 - Present

  Responsible for the following: Conduct a review of Medicare Part A /B claims on services questioned on appeal by the provider or facility of the service, beneficiary, Centers for Medicaid and Medicare Services (CMS) or other interested parties. Requests may be either written or telephonic. Render an independent decision based on research of the initial claim processing activity, documented procedures/policies, and information supplied with the appeal request. Initiate a response to the inquirer and appropriate parties to the appeal in the form of an adjustment to payment, refund request for overpayment or written correspondence when upholding the processing of the service. Work within multiple computer applications, such as: the Standard Medicare System (MCS), Fiscal Intermediary Standard System (FISS) Ability to make independent decision relating to claims processing accuracy relying on various on-line reference tools. Sound research/decision making skills to respond to the inquiry in accordance with Medicare procedures/guidelines. Good verbal/written communication skills along with solid customer service skills. A thorough knowledge of Medicare policies/benefits, internal processing instructions, as well as medical terminology including Medicare claims processing. Essential Job Functions: Respond timely to Medicare inquiries that constitute an appeal or reopening of an initial claim determination. This involves: Research electronic files, imaged records and/or accessing the appropriate external systems, reading/interpreting processing guidelines determining the accuracy of the original claim determination and taking the necessary actions to finalize the case file. Perform claim correction activity of the initial claim determination when an additional payment or a reduction in payment correction is necessary. Generate written correspondence, to the inquirer and other parties to the appeal, in response to an affirmation of the initial claim processing. Show less



Days Inn by Wyndham

• United States
• Hospitality
• 700 & Above Employee

• Front Office Manager

  • Jan 2007 - Aug 2012



Walmart

• United States
• Retail
• 700 & Above Employee

• Customer Service Manager

  • Oct 2001 - Nov 2006



Kmart

• United States
• Retail
• 700 & Above Employee

• Cashier Supervisor/Layaway

  • May 1999 - Mar 2001