Rose Herbst

About Rose Herbst

A team player with strong communication skills and shows compassion in their work. Excellent telephone etiquette with an ability to maintain confidentiality and discretion as well as exceptional Microsoft Office skills.

Experience

1. Case Coordinator

   Commonwealth of Pennsylvania

   Jun 2024 — Present

   Conduct retrospective reviews to determine if dental services were provided, billed and paid in accordance with applicable state and federal regulations through research, analysis and application of regulations, policies and standards of care- Evaluate the appropriateness of care, including medical necessity, place of service, quantity, quality and compensability of services ordered and provided to recipients in the Fee-for-Service and Managed Care delivery systems- Review claims and encounters to identify those providers/recipients whose billing/service patterns indicate fraud/waste/abuse- Review medical and fiscal records to determine if records were properly maintained, reflect services rendered and meet required standards of practice- Discuss case findings with dental consultant, supervisor/manager, DHS attorneys and law enforcement agencies, as warranted, to determine administrative action or referral to other state and federal agencies or law enforcement- Prepare correspondence, referrals, and reports- Respond to inquiries from providers or recipients.

Education

• Keystone Technical Institute

  Certificate, Dental Assisting/Assistant

• HACC, Central Pennsylvania's Community College

  General, Dental hygiene

• Central Dauphin High School

  General

• HACC, Central Pennsylvania's Community College

  Art/Art Studies, General

• Fortis Institute-Scranton

  Associate's degree, Specialized Technology