Jasmine Joseph

• Supports the daily operations of Care Coordination, Utilization Management, Concurrent Review, Retrospective Review, and Prior Authorization teams through interaction with staff, facilities, vendors, and providers
• Cases are routed to appropriate Keystone Mercy Health Plan associates based on established guidelines
• All incoming and outgoing correspondence/faxes are processed according to required standards and within respective timeliness guidelines
• Cases are referred to the appropriate clinical team members for review as defined by workflow
• Communicate directly with members to identify needs and provide information on healthcare access, preventive health interventions, and screening.

- Prepare and submit insurance claims for reimbursement.

- Verify patient insurance eligibility and benefit details.

- Ensure accurate medical coding for all services rendered.

- Investigate and resolve billing discrepancies and claim denials.

- Maintain organized records of claims, payments, and adjustments.

- Communicate effectively with healthcare providers, patients, and insurers.

- Ensure compliance with healthcare regulations and billing policies.

- Generate and analyze reports on reimbursement trends and issues.

- Follow up on unpaid claims to ensure timely resolution.

• Identifies and records required billing information according to insurance carrier requirements with 100% accuracy
• Completes billing information accurately
• Processes claims electronically with 100% accuracy and mail claims to insurance carriers daily
• Enters documentation and adjustments through computer system to maintain a correct account balance
• Updates system information daily according to correspondence received and processed
• Documents any changes on a daily basis and submits information to appropriate personnel
• Seeks clear directions to resolve issues and bring problems to a proper resolution
• Reviews and identifies charge discrepancies and completes all requests for rebilling from inter-department personnel.

• Reviewed case files, ensured all documents were legible, accurate, and complete
• Worked with Federal Emergency Management agency preparing, preventing, responding, and recovering from all domestic disasters
• Schedule and Conduct Intake meetings/consulting
• Used Microsoft excel to create spread sheet statistics and diagram skills
• Verified all documentation for client and pushed case to upper management
• Conducted a file closeout process
• Explain appeal process to applicants as needed
• Assists families with applications to restore housing programs through FEMA.

• Transferred data from paper formats into computer files or database systems
• Typed data provided directly from customers into company systems and forms
• Provided tax estimates and consultation assistance.

• Listened and responded to customer complaints
• Created and ensured a positive customer experience for guests
• Processed returns, refunds, exchanges
• Handled large quantities of cash flow.

• Answered telephones, gave information to callers, and transferred calls to appropriate individuals
• Verified insurance coverage, and eligibility, and processed authorization requests
• Greeted visitors and callers, handled inquiries, and directed them to the appropriate persons according to their needs
• Updated patient records and medical information release request.