medical claims recovery, adjustment and auditor

15 Plus Years: As a short- term traveling contractor, I have experience with HMO’s, as well as, PPO Insurance companies. Job descriptions are as follows: Experience in claims processing of Medicaid, Commercial, Professional, PPO, HMO, Third Party, Subrogation And Medicare claims Team Lead for high dollar and complex claims issues as well as customer service responses. Provider Relations Liaison, as well as, being a trainer for Medicaid hospital and Blue card processing claims for overpayments. Also, I have experience auditing processed claims, Stop Loss payments, reading contracts, Matrix checks for coordination of benefits, posting refunds and resolving provider and vendor record issues as well as correspondence. I have supervised groups from 6 to 60 people. Adjustments and recovery from both providers and subscribers. Research payments and audited adjustments, recertification of Medicare benefits and Commercial long term care. Reconfiguration of hospital rates and denial codes, as well as, update providers records. I have worked recoveries from paper and core.

Claims Examiner

Discovery Bay, CA