Casey Jaquez

Medical Reimbursement Specialist @NewYork-Presbyterian Hospital

Manhattan, NY, US

Identify underpaid claim payments through variance reporting by having acomprehensive understanding of CPT, HCPCS II, and Modifiers claim structureand their relationship to payor specific guidelines and CMS guidelines inExperian Contract Manager.• Working knowledge of reimbursement methodologies such as Multiple ProcedureReductions, RBRVS, Endoscopy Families, Always Therapy, NCCI edits, andMedicare Administrative Contractor Localities to identify underpayment trends.• Perform manual processing of client billing contracts within EPIC systems,ensuring accurate billing by reviewing patient medical records documentation.• Participate in CPT code analyses and undercharge reports.• Identify and report underpayment trends to Manage Care and attend monthlymeetings with the payor to discuss recovery payments.• Perform Experian contract definition maintenance by updating contracts inExperian with newly contracted rates or payor guidelines.• Review and report unlisted CPT codes for relative value unit (RVU) reportingpurposes, by utilizing their corresponding comparison code(s).• Work independently, manage multiple insurance contracts and priorities, andmeet deadlines.• Train new employees within the department.