Dynamic healthcare professional who demonstrates strong analytical, communication, and teamwork skills, with proven ability to handle multiple task effectively. Skilled in HIPAA compliance, organizational management, and fostering collaboration with healthcare partners. Brings positive attitude and commitment to continuous learning and growth.
• Attend meetings and educational conferences on behalf of the Immunization Division.
• Ensure compliance of the VFC program by all South Carolina Immunization Providers.
•45% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
•45% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards.
•10% Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations.