United American Health Care (U.A.H.C)
Claims Inquiry/Provider Inquiry Supervisor-C.O.B Specialist-Lead Analyst
September 1991 — October 2002
Supervised 13 Claims Inquiry/Provider Service Inquiry Representatives by monitoring telephone inquiries to ensure adequacy and proficiency of relayed information; trained Lead Analysts, Claims Analysts, Claims Inquiry Representatives, Provider Service Inquiry Representatives and Coordination of Benefits Specialists; Implementation Team Leader for upcoming MC400 automated adjudication system to entail development of configuration logic, benefit categories, fee schedules and adjudication rules. C.O.B Specialist-researched and determined carrier liability through possibility of coordinated benefits using the longevity law, birthday law, or the gender rule; retrieved any payments made prior to knowledge of other carrier by processing information letters of credit retrievals or reimbursement requests; structured subrogation cases with attorney's office for workmen's compensation or lawsuit compensation; resolved correspondence requests for denied claims. Lead Analyst-processed inpatient admissions, outpatient procedures, office visits, home health, physical therapy, vision, radiology and laboratory claims; responded to payments other than anticipated (P.O.T.A) requests; resolved and reprocessed denied/rejected claims.