Typhanie Clemons Claims Research

Decent Essays
Typhanie Clemons

Experience
Claims Research/Customer Service Representative (Temporary) 03/2015-05/2017
MD Wise, Inc. (Damar Staffing)
• Accurately submitted claims for reprocess in accordance with the claims processing system and other department guidelines
• Investigated and resolved claim concerns
• Reversed and reprocessed claims as necessary
• Managed inbound calls to resolve payment issues and take payments over the phone
• Responded to specialized claims inquiries from patients and providers
• Properly handled and documented calls in timely fashion
• Ensured that appropriate follow-up to claims inquiries/requests is complete and timely

Rehabilitation Specialist 02/2012-06/2014

Related Documents

  • Improved Essays

    Nt1310 Unit 3 Assignment 3

    • 1039 Words
    • 5 Pages

    Group I, Category 19 Incorrect RFC Decision ISSUE DDS proposed a denial determination. The evidence in file supports a more restrictive RFC, as a result, additional vocational documentation is required. CASE DISCUSSION & POLICY ANALYSIS (INCLUDING SPECIFIC REFERENCES) This 57-year old is filing a DIB claim alleging disability due to loss of right eye, COPD, high blood pressure, edema of both legs and feet, back surgery, weight gain, depression, and neuropathy, as of 10/22/2014.…

    • 1039 Words
    • 5 Pages
    Improved Essays
  • Decent Essays

    Thank you Madeline for the response. Also I review the claim for the patient Williams,Elmira DOS 02/29/2016 and I see that the claim missing the authorization number since the patient have as a payer St.Francis Life. Would you please review and add the missing information on claim. Please email back so I can add the authorization number on the original claim that I will Hold in Trizetto.…

    • 66 Words
    • 1 Pages
    Decent Essays
  • Improved Essays

    They are both versed in every aspect of the billing process, and, ensure that our specialsits are following our follow up and documentation procedures. Their attention to detail, and adherhence to DM Medcial Billings processes, have resulted in excellent collection rates, and have seen them each move into mangement and supervisory positions, within DM Medical Billings. Resumes are attached. DM Medical Billings has never had any lawsuits and or public judgments in its 19 year history. DM Medical Billings performs background checks, and all potential employees are screened prior to being made an offer of employment.…

    • 440 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    Every Friday at 11 o’clock in the morning, I came along with the clinical pharmacist to round with the physician, nurses, physical therapist, and a case manager. The physician presented conditions and the medical plans for the patients then listened to perspectives of the team. The pharmacist…

    • 509 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Mr. Chavez stated that the claimant’s job required the claimant to use handheld tools along with small and large equipment such as wheel barrels, forklifts, and Bobcat Skip loaders. He stated that the physical demands of his job were 100 % that consisted of pushing, pulling, lifting, kneeling, and bending while using the handheld tools. Mr. Chavez said the claimant’s job required the claimant to lifting an average 90 pounds to include items such as bags of concrete, roofing materials, mortar, boxes of tiles, sinks, lavatories, doors, and street lights. Also, to these duties of carrying and lifting items, the Claimant’s physical functions requires the Claimant to perform the following physical motions: Kneeling, squatting, bending at the waist and bending at the neck.…

    • 592 Words
    • 3 Pages
    Improved Essays
  • Decent Essays

    1098 claims were originally processed for Waverly Health Ctr under the wrong ID#. This caused the claims to pay $9.77 for code T1015. Those claims are currently being reprocessed for the correct payment of $ 223.97. The claims have an ETA completion date of 12/16. Furthermore, a fix is also being put in the system to ensure that future claim don’t have this issue.…

    • 70 Words
    • 1 Pages
    Decent Essays
  • Great Essays

    Aetna Case

    • 691 Words
    • 3 Pages

    As you know, this law firm represents Gulf Coast Division, Inc. and its constituent hospitals (collectively, the “Hospitals”). Reference is made to the Hospital Services Agreement (effective February 1, 2004 and all amendments thereto (collectively, the “HSA”). On June 2, 2005, we sent a demand letter to Aetna Health, Inc. in regard to its failure to have reimbursed the Hospitals in accordance with the HSA for items billed by the Hospitals as “Other Implants,” as defined by Revenue Code 0278. On January 15, 2016, we provided you with a copy of the Hospital’s Arbitration Demand that would be filed if no pre-arbitration resolution could be reached (see attached copy). The facts of this matter and the claim being asserted by the Hospitals…

    • 691 Words
    • 3 Pages
    Great Essays
  • Decent Essays

    I am writing in response to Mr. Maggio’s inquiry to the Illinois Department of Insurance dated April 11, 2017. In the inquiry, Mr. Maggio expressed concerns regarding being enrolled in the incorrect health insurance policy and health insurance claims being denied. Andrew, Rachel, Archer and Evelyn Maggio have coverage under the BlueCare Direct Silver 104 with Advocate Individual Health insurance policy effective January 1, 2017. The policy is currently active and paid through March 31, 2017. After a review of the concerns presented in Mr. Maggio’s inquiry to your office, we have corrected our systems to properly reflect coverage for Andrew, Rachel, Archer and Evelyn Maggio under the BlueCare Direct Silver 104 with Advocate Individual Health insurance policy effective January 1, 2017.…

    • 220 Words
    • 1 Pages
    Decent Essays
  • Improved Essays

    In 2010, then Secretary of Veterans Affairs (SECVA) Eric Shinseki recognized the need to transform the department and set out to modernize and improve Veteran Services by focusing on the in the areas of people, processes and technology. The department established as one of its priority goals to “Improve Veteran access to VA benefits and services.” In response to this goal, the department began a major transformation initiative. As part of this initiative, the Veterans Benefits Administration (VBA) established National Call Centers (NCC) to open channels of communication and allow claims processors to place greater emphasis on reducing the claims backlog.…

    • 679 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    administrative and interest fees are applied. Interest fees will not accumulate until after the suspense date on the debt letter. Interest fees are processed as a DS01, company code E000088. 4) If a proration is requested and approved, then administrative and interest fees are applied.…

    • 1225 Words
    • 5 Pages
    Improved Essays
  • Decent Essays

    Hi Maddison, I still would suggest putting in an appeal. If we don’t have the codes in the system. Once we have them in the system those claims will be the first to be reprocessed. Having the appeal in the system is the best way to capture those claims that are effected.…

    • 60 Words
    • 1 Pages
    Decent Essays
  • Decent Essays

    (a)Compliance management should update the HMDA-LAR procedures to include additional steps in identifying and validating loan applications when the customers/consumers are applying as non-natural persons and originating as consumer purpose loans secured by a primary residence (dwelling). Compliance management should communicate updates of policies and procedures to all employees impacted by the changes. (b)The HMDA Specialist/Supervisor should enhance the HMDA-LAR data scrubbing process performed during each quarter to include exception reporting for identifying applications that changed during the application process, and validating the accuracy and completeness of GMI-related data prior to each HMDA-LAR submission. In addition, the…

    • 157 Words
    • 1 Pages
    Decent Essays
  • Decent Essays

    Unclaimed Shift Allowance

    • 261 Words
    • 2 Pages

    Please see a number of points I would like you to take into consideration when reviewing my unclaimed shift allowance, as detailed above. I accept full responsibility for not processing this allowance at the time however, I would like to provide you with some background information prior to when I returned to collections as a CAD in January 2013. · I had not previously claimed shift allowance since 2010, as a call taking associate working part time I did not fit the criteria to claim. This was not a process I was familiar with completing for myself in some time. After a 10 month secondment in Fraud in 2012 I returned to C/A as a CAD, in January 2013.…

    • 261 Words
    • 2 Pages
    Decent Essays
  • Decent Essays

    Faxe Process Analysis

    • 571 Words
    • 3 Pages

    When a technician receives a fax, there is varies steps that the faxes go through before member is notified. A technician will first open up pas and hit get next fax. The technician should always open up the Part D faxes first to work then continue to the other work baskets. After selecting hit next fax, the technician will open up an attatchment, which will be the fax image to work the case. Some faxes is barcoded and all the information will be prefilled but a tech should always verify that the information is correct.…

    • 571 Words
    • 3 Pages
    Decent Essays
  • Great Essays

    Senwes Case Study

    • 2751 Words
    • 12 Pages

    Risks identified by Senwes: These are the major risks that have been identified by Senwes: • Increase in pricing by their funders • Farmers purchase direct from suppliers - prices are cheaper and it is more comfortable • Competition from banks - rates are a problem • Uncompetitive product offering by Hinterland • Land reform and intervention by Government- missing opportunity • Loyalty scheme – Senwes don’t have one while competitors have one in place Risks identified by Silverstone Limited: These are additional risks that have been identified by Silverstone Limited: External risks • The buying of the NWK debt book - Risk that their debt policies differ from that of Senwes. There is a risk that NWK might lose clients, which…

    • 2751 Words
    • 12 Pages
    Great Essays