Sharee Abernathy

• Research/rectify third party denials/edits, requests for information and other related correspondence for Commerical and Medicare claims.
• Process a variety of Third Party Administrator (TPA) payments
• Handled 60-100 weekly to payers when needed
• Increased customer satisfaction levels by promptly addressing inquiries regarding billing issues or adjustments needed on their accounts.
• Analyzes and clears payment variances
• Verify patients' eligibility, coverage, and benefits and identify authorization requirements relates to working aged AR.
• Follow-up on outstanding account balances at 30-days from the date of service in accordance with client and organizational protocol with an emphasis on maximizing client satisfaction and provider profitability.
• Process timely premium payments to providers
• Research and answer accounts receivable discrepancies
• Monitors payer responses, and other software as necessary to ensure prompt payment
• Analyzed trends in payment patterns and customer behavior, identifying opportunities for process enhancements that would improve overall AR performance.
• Processed reconsiderations and appeals when necessary

• Assess benefit eligibility and provider eligibility for long term care policy holders by reviewing policy triggers, medical records, MDS's and billing to make decisions.

• Provided care coordination to 200 caseloads per month, of adult population diagnosed with dementia, Alzheimer’s, and other chronically and terminal diseases.

• Generate daily claims reports and track trends for the Care Management Department.

• Ensure successful claim outcomes by achieving prompt claim closures, high client satisfaction with claim services, effective claim cost containment.

• Communicate with the insured, insured's representative or provider to follow-up on information needed to process outstanding claims.

• Perform all functions through the initial review of the onboarding process to assure that Independent Caregivers, Home Health Care Agencies and Skilled Nursing Facilities meet the Long-Term Care plan's requirements for care as a contracted provider.

• Used company software and databases to maintain records of services performed and patient conditions.
• Maintained accurate and up-to-date documentation of patient records in accordance with HIPAA regulations.
• Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.

• Improved patient satisfaction by efficiently processing medical insurance claims and addressing inquiries.
• Collaborated with healthcare providers to resolve billing discrepancies, fostering positive relationships between parties involved.
• Expedited resolution of customer concerns, providing exceptional service through clear communication and active listening skills.
• Managed high call volume while maintaining accuracy and professionalism in documentation of interactions with customers.
• Billed health insurance claims to ensure resolution of accounts and submitted contractual adjustments,

reviewed contracts and processed appeals and denials.

• Reduced claim denial rates with thorough reviews of medical records and accurate coding practices.
• Increased efficiency in claim filing by identifying trends in common errors, suggesting improvements to internal processes accordingly.
• Verified patient insurance coverage and benefits for medical claims.
• Followed up on denied claims to verify timely patient payment and resolution.
• File correct UB04s and 1500 HCFAs with subrogation information to primary and secondary payers for payment.
• Maintained detailed case files, facilitating easy retrieval of information for future reference or audits.