Erica Culler

I receive and check in clients for one on one and group therapy sessions and noting arrivals on finance sheets. I am responsible for receiving large volumes of calls, taking messages, transcribing messages into emails and transferring calls to appropriate persons or voicemail. I reconcile information with regard to finance and insurance eligibility via electronic verification systems in PA Promise. I index clients, collect monies, write receipts, prepare accounting packets for the accounting department, make appropriate copies, and deposit finance packets into the safe once all is completed. I troubleshoot and resolve issues for clients, clinicians, and psychologist with regard to policy and procedures, appointments, transportation, building maintenance, and office supplies. I am responsible for the timely filing of sensitive documents into case files and the creation of new chart files. I place calls clients regarding eligibility changes, payment plans and reminder calls for polygraph appointments. I call references for, and verify employment, outpatient therapist candidates and student practicums. I print client schedule and group finance sheets and group sign-in sheets.

Confirm patient name and account number are on every page in the record front and back. Prep all pages for the scan process (i.e., removing staples and making sure that the quality of the document is readable). I examined pages and verified patient identification on each page. Inspects the quality and accuracy of each document scanned. I prioritized the batches in the queue and retrieve the batches for processing. Confirm that all records ready for indexing have been received. I reviewed each electronic image within the batch. Compare with hard copy to confirm image quality, appropriate order and appropriate rotation. I determined the correct patient name, account number, document type or section (if appropriate) I indexed the image (encounter, section or document) appropriately by required patient date elements according to JUP specific guidelines. I reviewed each image and verify the following: a. I corrected patient name and account number. b. Proper indexing into the patient chart grouping. I identified errors requiring correction in accordance with policies and procedures. I interacted with co-workers, visitors, and other staff consistent with the iSCORE values of Jefferson. I facilitated continuity of care via release of information to medical professionals.

QUALITY SPECIALIST I was responsible for the timely and accurately review of provider set ups directly related to provider network database auditing. I assumed some lead responsibilities including high level report preparation, rebuttal/appeal coordination and representing the department when interfacing with service teams. I utilized system applications including Facets, Word, Excel, Access, Microsoft Outlook and Maces IMAX. I utilized provider maintenance business rules, provider maintenance mapping and processes for achieving required quality standard criteria established for all lines of business. I researched, and investigated and accurately recorded audit findings; documented errors and audit statistics. TECHNICAL SUPPORT REPRESENTATIVE Selected Contributions I negotiated pay rates for inpatient/outpatient services that were not under contract and negotiated payments for providers that were out of the network. I processed newly credentialed providers into the database by determining fees, contracts, specialty codes and created new provider numbers based on these findings. I responded and resolved provider issues and request for multiple changes and additions to their databases. I responded and resolved internal inquiries regarding claims and provider systems. TECHNICAL SUPPORT CLERK I maintained provider network databases including demographic, financial, panel restrictions and terminations. I data entered newly credentialed providers. I completed laboratory changes in the database for primary care physicians and created correspondences to notify all parties.