Paige Washington

• Document 20–30 patient encounters daily, ensuring complete and accurate medical records for billing and claims purposes

• Apply ICD-10 and CPT codes to support proper claims adjudication and reimbursement

• Review clinical documentation to identify discrepancies and ensure compliance with regulatory standards

• Collaborate with providers and care teams to improve documentation quality and patient outcomes

• Support referrals, order entry, and care coordination processes across systems

• Managed investigations of benefit claims by gathering evidence, conducting interviews, and analyzing documentation

• Determined eligibility and identified discrepancies using established policies and guidelines

• Maintained detailed case files and documented findings to support claim decisions

• Collaborated with internal teams to resolve claims efficiently and accurately

• Managed a high-volume caseload, determining eligibility for Medicaid and other state programs

• Reviewed applications and supporting documentation to verify coverage and resolve inconsistencies

• Communicated decisions and next steps to clients, ensuring understanding and compliance

• Applied regulatory guidelines to support accurate benefit determinations

• Processed eligibility updates and changes for healthcare and state assistance programs

• Ensured compliance with documentation standards and program requirements

• Resolved customer inquiries through effective communication and problem-solving techniques.
• Utilized CRM software to track customer interactions and ensure timely follow-up.
• Collaborated with team members to enhance service delivery and streamline processes.
• Provided training for new staff on customer service protocols and best practices.