Janu Rey T. Azarcon

Duties:

• Patients Data Review
• Checking Eligibilities and Verifying if patient had other Insurance.
• Reviewing Procedure Codes and Diagnosis Codes
• Uploading Patients Documents in Dr.Chrono.
• Clinical Notes Review by checking if signed by the Supervising Doctors and Assistant Physician or Rendering providers.
• Reviewing Doctor’s Clinical notes to see if Diagnosis were Accurate as well at its Dosage, checking to see if the Injection Series are Correct, as well as the coding used.
• Deleting, adding codes/diagnosis codes as well as unit Input before billing Claims. ( Data Entry )
• Settling accounts for SELF PAY patients by tagging them as PAID IN FULL
• Data Export and distribution of clinical
• Sending clinical notes to clearing house for Correction such as incorrect Dosage and incorrect Chief of complaint for Injection Series and clinical notes Unlocked.
• Monitoring scrub claims to see if it was accurately billed.
• Providing feedbacks and Updates.
• Insurance Verification for Benefits and Authorization

Position:

Tempo TM (Handles adjustment Team)
Claim Examiner
PLOG Analyst
Enrollment and Benefits Escalation Specialist
Pricing Specialist (BURGESS_PRICING)
Authorization Specialist ( EVICORE and UTILIZATION MANAGEMET )
Benefit Exception Specialist

Duties
-Assist members in their billing concerns
-Process adjustments in claims to pay or deny
– Verification of claims if correctly denied or accurately paid
-Verifying pricing of claims (Burgess Pricing)
-Checking benefits of members according to their subscription
-Follow up authorization for procedures
-Editing/uploading Authorizations from Carecore(EVICORE)- UM (Utilization Management )
-Sending escalation review of Benefits and claims
-Sending emails to the members for their participating provider
-Sending Benefit exception for Carecore (EVICORE ) review as well as Benefits Exceptions for Patients Coverage
-Call listening /Verification of Benefits
-PLOG analyst
-Escalation specialist for Enrollment Discrepancy