Experience

Reqroute, Inc

• Staffing and Recruiting
• 1 - 100 Employee

• Claims Specialist

  • Dec 2016 - Present

• Claims Specialist

  • Dec 2016 - Present

   Responsible for the research and resolution of assigned projects.  Coordinate with area departments in the identification of issues/trends.  Collaborate with area departments on policies, procedures and resolution issues.  Utilize provider billing and claims processing knowledge.  Identify documented issues and provide notification of resolutions.  Monitor/maintain aging projects.  Work effectively in a remote setting compliant with company standards.  Research… Show more  Responsible for the research and resolution of assigned projects.  Coordinate with area departments in the identification of issues/trends.  Collaborate with area departments on policies, procedures and resolution issues.  Utilize provider billing and claims processing knowledge.  Identify documented issues and provide notification of resolutions.  Monitor/maintain aging projects.  Work effectively in a remote setting compliant with company standards.  Research using DMS, and HIPAA Gateway applications.  Process claims using Facets System.  Process claims adjustments due to corrected claims.  Assist other departments as needed.  Independently review, analyze and make appropriate claim determinations.  Work all claim edits to ensure claims finalization and complete adjudication.  Compliance of current state/federal claims regulations.


Superior Health Plans
• Insurance
• 100 - 200 Employee
• Appeals Liaison Specialist

  • 2012 - 2013