Mahogany Bell

Senior Claims Analyst @Molina Healthcare

US

Answer, research and respond to complex provider inquiries in collaboration with claims analysts and technicians.Monitor and work with multiple TPA’s (third-party administrators) to correct any inaccurately paid claims.Investigate and review provider appeals of denied claims for all benefit programs.Make recommendations to the Appeal Committees for payment reconsideration, arrange meetings and present findings to the Committees, prepare combined quarterly report for submission to DHS (Department of Health Services). Review TPA (WPS) reports such as offsets, EVV (electronic visit verification), M8 and assess that claims are paid correctly.Work collaboratively with Data Analytics team on periodic systemic reviews of claims paid while member was hospitalized.Assist with the processing of retro rate adjustments for multiple TPA’s and ensure payment is made to provider. Identify, research, and implement process improvements. Provide education and training to network providers to ensure timely claims for payment of member services; includes occasional travel to provider’s location. Update T19 codes based on changes in the T19 fee schedule relative to the coverage of codes in the Family Care Benefit package, addition of codes, or the deletion of codes. Work with MIDAS Developers to design and test reporting or system changes. Identify IDT (interdisciplinary team) training needs and work with IDT leadership to complete the training. Monitor for changes in the benefit packages of all benefit programs (Family Care, Partnership, Medicare Dual Advantage, SSI, and BadgerCare)