Sentences with phrase «eligibility of medical claims»

Talented in determining the eligibility of medical claims by performing in - depth reviews of claim requests, adjudicating medical claims and taking appropriate actions to resolve discrepancies, utilizing up to date processes and procedures to update claims in the database and responding to claimants by staying within company standards to ensure absolute conformity and reduced risk for ambiguity.

Not exact matches

However, before buying any Emergency Medical Travel Insurance policy, it's extremely important to know of any contractual limitations that could impact your eligibility in the event of a claim.

Final determination of medical expense eligibility will be made by the claims department AFTER the claim has been submitted (either by the provider directly or by the insured).

• Complete understanding of medical terminology, billing and coding, and providing patient - centric service and support as well as critical follow up on all insurance claims and eligibility issues.

Medical Billing / Follow — up Specialist (Contract)--(Daughters of Charity), Redwood City, CA 2008 Extensive knowledge of National Government Services Website used to research and determine eligibility, copayments, co-insurance, and claim status.

Major Duties of the Medical Reimbursement Technician include, but are not limited to... Validates claims for billing purposes ensuring eligibility and referring questionable coding for...

• Assess all insurance claims against patient services rendered and make a to do list • Assist patients in filling our insurance claim forms and verify form data • Ask questions to assist in determining out any ambiguous information • Verify completeness of information on medical insurance forms • Post insurance billing information data into predefined database systems • Make list of insurance companies to contact for billing purposes • Determine how to approach each insurance company on the list, based on its reputation • Contact insurance companies to determine status of claims • Follow up on unpaid claims, including denial, exceptions and exclusions • Ask why claims have been denied and provide relevant correlating information • Resubmit denied claims with additional information to prove denial is inappropriate • Provide information to collection agencies regarding delinquent or past due accounts • Prepare and submit secondary claims for patients with more than one insurance coverage • Maintain understanding of managed care authorizations and limit coverage to a certain number • Verify patients» benefits eligibility and coverage expanse • Maintain knowledge of ICD9 and CPT treatments to be able to handle data entry and claim check duties appropriately • Gather and maintain patient data including medical histories, insurance identification and diagnosis

Executive Consultant in establishing a start - up health plan for all technical, business and operational and data management and information systems security areas including member enrollment and eligibility, developing coverage, benefits and plan products including procedure and diagnosis codes, claims processing with rules definition, billing and premium, provider - physician and hospital contracting, credentialing, provider reimbursement methodologies, finance, revenue and payments, clinical care, medical management and authorizations and coverage guideline policies, broker / agent operations, EDI, IT Integration, IVR scripting, Microsoft SharePoint and C - Suite data management and reporting, and all Kentucky Dept of Insurance product and benefit filings including SERFF and HIOS.