EMPLOYMENT

CONFIDENTIAL

• Works closely with quality assurance department to ensure company objectives are met
• Reviews and responds to claim referrals and questions from claims staff
• Reviews and responds to claim appeals and grievances
• Investigates and responds to complaints regarding claims processing
• Communicates with program partners as directed by Program Manager regarding claim related matters
• Performs claim reviews and makes recommendations based on policy provisions and processing guidelines
• Maintains company production and quality standards of 98 statistical accuracy and 99 payment accuracy
• Participates in proposal writing and responds to claims procedural inquiries
• Prepares claim audit reports for pre-payment.
• Analyzes Audit reports to identify training issues and develops training programs
• Takes responsibility for training of Claim Examiners as needed
• Facets, Onbase and Maccess systems

CONFIDENTIAL

• Works closely with quality assurance department to ensure company objectives are met
• Reviews and responds to claim referrals and questions from claims staff
• Reviews and responds to claim appeals and grievances
• Investigates and responds to complaints regarding claims processing
• Communicates with program partners as directed by Program Manager regarding claim related matters
• Performs claim reviews and makes recommendations based on policy provisions and processing guidelines
• Maintains company production and quality standards of 98 statistical accuracy and 99 payment accuracy
• Participates in proposal writing and responds to claims procedural inquiries
• Prepares claim audit reports for pre-payment.
• Analyzes Audit reports to identify training issues and develops training programs
• Takes responsibility for training of Claim Examiners as needed

CONFIDENTIAL

Validated the information on all medical claims received. Reviewed and ensured that there was no missing or incomplete information. In addition, I kept meticulous records of claims and follow up on lapsed cases. I met the required QA score and daily production. Received detail training on HCFA 1500 and UB04 claims processing and CPT code ICD9 training. Received phone calls from members and providers with claims issues and resolved in a timely manner. HIPPA certifications were renewed yearly. I have an expansive knowledge of medical terminology, as well as experience using a computer.

CONFIDENTIA

• Manage day-to-day operations of dental office
• Open and close dental office according to office protocol
• Review the office for a neat, professional appearance and make necessary changes
• Check the daily schedule for accuracy and post it in all treatment rooms
• Answer and respond to telephone calls with professionalism
• Review supplies for reception
• Maintain petty cash
• Ensure that HIPAA Notice of Privacy Practices Notice is on display
• Started a recall system for routine check ups
• Established new practices so the office became more profitable
• Update insurance information on all patients at all times
• Submit treatment plans for predetermination of benefits
• Prepare claim forms for patients with dental insurance
• Organize supporting materials for claim forms, such as radiographs or written narratives
• Mail or electronically submit claim forms from office
• Assist in the resolution of problems with third-party payers
• Greet and welcome patients and visitors to the practice
• Check in patients according to office protocol, verifying and updating patient information
• Manage recall and inactive patient system
• Oversee patient relations handle patient complaints
• Help explain office policy to patients
• Confirm the next day's appointments according to protocol and patient preferences
• Schedule patients for efficient use of doctor and staff time
• Check patient quick-fill list to try to fill in cancellation and no-show appointment times
• Collect payment from patients at the time of treatment
• Make follow-up appointments as needed
• Prepare financial treatment plans and present plan options to patient at end of their appointment

CONFIDENTIAL

• assisting the dentist during a variety of treatment procedures
• taking and developing dental radiographs x-rays
• asking about the patient's medical history and taking blood pressure and pulse
• serving as an infection control officer, developing infection control protocol and preparing and sterilizing instruments and equipment
• helping patients feel comfortable before, during and after dental treatment
• providing patients with instructions for oral care following surgery or other dental treatment procedures, such as the placement of a restoration filling
• teaching patients appropriate oral hygiene strategies to maintain oral health e.g., tooth brushing, flossing and nutritional counseling
• taking impressions of patients' teeth for study casts models of teeth
• performing office management tasks that often require the use of a personal computer
• communicating with patients and suppliers e.g., scheduling appointments, answering the telephone, billing and ordering supplies
• helping to provide direct patient care in all dental specialties, including orthodontics, pediatric dentistry, periodontics and oral surgery
• Prepare financial treatment plans and present plan options to patient