Mariah Goodrich

• Submit Specific and Aggregate reimbursement requests to stop loss insurance carriers accurately and timely, following standard operating procedures.
• Administer advance funding when included in a group’s stop loss policy
• Efficiently address questions and requests for information from the stop loss carriers, clients, and brokers and gather all supporting documentation from corresponding departments as necessary
• Correspond with MedCost clients to verify that enrollment eligibility was maintained based upon plan documentation
• Reconcile monthly and year end reporting to reflect reimbursements, refunds, voids, etc.
• Assist with researching and resolution of client issues related to stop loss transactions
• Assess the need for a sense of urgency with all work activities and communicates appropriately
with department leadership to coordinate response/resolution
• Provide reporting to internal and external requests as needed
• Develop and maintain relationships with the MedCost customers (internal & external) by
providing an array of expertise and collaboration
• Evaluate opportunities for process improvement and implement solutions producing desired outcomes
• Other duties as assigned. Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes. Established proof of loss by studying documentation and assembling additional information from outside sources. Assisted claimants, providers and clients with problems or questions regarding stop loss claims

• Worked with speed, efficiency and accuracy to process documentation and complete projects.
• Managed electronic health record quality assurance processes by organizing and handling requests for medical records and charts.
• Utilized copying equipment for medical record duplication, answered phones and filed documents.
• Maximized accuracy and completeness of medical records through in-depth audits and patient information reviews.
• Completed in-depth audits of performance and quality of current charts and processes through facility reviews.
• Handled various departmental responsibilities, which included health information release.
• Maintained complete confidentiality in accordance with organization and legal requirements.
• Met needs of physicians and other treating team members with timely retrievals of patient medical records.
• Protected medical information against unauthorized access, loss or corruption by consistently following security protocols.

• Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
• Acted as liaison between business department, billers and third party payers in resolving billing and reimbursement accuracy.
• Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
• Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
• Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
• Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
• Contacted insurance carriers to obtain authorizations for services delivered to patients.
• Worked with insurance companies and patients to determine best courses of action.
• Conducted complex research, review and analysis of medical records, treatment plans and claim information.
• Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
• Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
• Verified policy holder data, including age, contact number and physical address.
• Complied with confidentiality regulations in handling customer information.
• Verified patients had proper insurance coverage prior to procedures or appointment scheduling.
• Corresponded with insurance customers and agents to obtain or relay information on account status changes.
• Retained strong medical terminology understanding in effort to better comprehend procedures.
• Created master spreadsheet to record procedures, denials and approvals.
• Detailed claims analysis to determine correctness and denial determinations.
• Complete appeals and retrospective authorization on denied claims.
• Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
• Acted as liaison between business department, billers and third party payers in resolving billing and reimbursement accuracy.

• Conducted complex research, review and analysis of medical records, treatment plans and claim information
• Participant of multi-departmental Denial Management Team.
• Participated in revenue cycle processes, working to maximize profitability and increase revenue.
• Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
• Corresponded with insurance customers and agents to obtain or relay information on account status changes.
• Updated patient and insurance data and input changes into company's computer system.
• Created master spreadsheet to record procedures, denials and approvals.
• Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
• Collaborated with Utilization Review Manager and Physician Advisor in group meetings to identify issues and find cost-effective solutions.
• Managed concurrent clinical requests from all payers and maintain processes pertaining to denials/appeals and potential denials as outlined by insurance carriers.
• Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
• Worked with insurance companies and patients to determine best courses of action.
• Investigated claims and reviewed coverage determinations.
• Built lasting relationships with provider practices and employees to underpin successful claims activities.
• Implemented process improvements after noticing several areas in underachieving department areas.
• Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
• Used Microsoft Word and PowerPoint to prepare reports, presentations and research results.
• Completed research assignments by organizing data, generating spreadsheets and drafting reports.