Description
stocker beneficiary's liability and entitlement. Contacted providers or beneficiaries to gather information and communicated disposition of cases and documented interaction. Maintained and coordinated existing appeals support system by opening mail, using alpha and numeric filing and HIMR to verify beneficiary names and Medicare numbers, and FISS dates of service. * Analyzed, reviewed, processed and adjudicated provider claims and appeals requests. * Processing claims for inpatient, home health, skilled nursing, outpatient facility and professional services * Verified member eligibility, benefit coverage and researched or applied authorizations * Summarized cases of a more complex nature, routing to nurse queue for more in-depth review.
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