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Pamela C. Car-Skaden

Expertise In: Orthopedic

Name : Pamela C. Car-Skaden
Experience : 16
Specialty : Orthopedic
Location : Jacksonville,FL
Description :

Pamela C. Car-Skaden has 16 years experience in medical coding and billing domain.

Skills:

  • Proficient in: Microsoft Outlook 2010 Word & Excel, Microsoft Visio 2003, IMS & RBMS Programs.
  • Proficient in: Electronic Correspondence Response System (ECRS) which is controlled by CMS.
  • Efficient in using Seibel
  • Update Merck Medco system for Medicare Part D members.
  • Add inquiries for the OPL HMO Unit’s II & I.
  • Utilize Convergence system

Experience:

  • Use Sapphire SQL Server Reporting Tools to pull various Adhoc reports based on business needs.
  • Segmentation support as needs arise.
  • Support lines of business including Direct Pay, Local Group & Blue Medicare as Medicare Compliance rules/laws change to meet CMS guidelines.
  • Collaborate with business partners and stakeholders to get desired data used to evaluate
  • Responsible for coordinating and facilitating meets with any business partner related to OPL as needs change to stay up with guidelines for all lines of business.
  • Support Product development by assisting the writing of Develop Business Requirement Process
  • Review and interpret the Medicare Secondary Payer(MSP) guidelines
  • Review and interpret the IRS/SSA/CMS Data Match Section 111 guidelines
  • Use Visio to develop Process Maps
  • Adhoc format spreadsheets as required including documentation as business needs arise.
  • Motivated to individual learning by using Skill Soft system.
  • Interact with IT to review/explain the Business Requirement Document (BRS).
  • Review Technical Design Document’s to approve or deny Business Processes are correctly formatted.
  • Being flexible to meet business demands and time lines
  • Develop Educational Documents to be used internally and externally
  • Set up JAR sessions to develop and discuss business processes
  • Research what areas are impacted by each process that changes are involving.
  • Set up test conditions and perform Unit Assistance Testing for OPL
  • Create Change Controls in Project Web Access
  • Experience with tracking Change Controls to review if they have been processed or closed
  • Work with Delivery Systems to develop Business Report Document’s as needed.
  • Responsible for coordinating and facilitating weekly MCU Support team meetings.
  • Managed the MPD & Sales mailbox to ensure all emails were responded to in a timely manner.
  • Audited emails from Group and Sales Representatives to the Director of Sales Administrator.
  • Work with the Sales & Marketing team to keep groups informed as to the status of their Medicare Payment Demands.
  • Work with groups to make sure Medicare Payment Demands are paid on time and correctly to avoid Treasury debiting their bank accounts.
  • Verify the member has the correct Health Order of Liability in the Coordination of Benefits System
  • Call the Center for Medicare and Medicaid Services (CMS) to update members Medicare information.
  • Contact Group Representative if any missing information is needed to complete the Medicare Payment Demand.
  • Review MHS and Diamond system for claims previously processed compared to the Demand information.
  • Manual keying and processing American Medical Association and UB92 claims into the MHS and the Diamond systems while calculating interest needed to pay Medicare directly.
  • Update the MPD database/SQL Server with correct information.
  • Suggest changes on the layout of the MPD database.
  • Transmitted correct Medicare Part D information to CMS thru Electronic Correspondence Referral System (ECRS)
  • Correct PRIME Therapeutics system with correct Medicare Part D member’s information.
  • Call 1-800 Medicare to make sure we have updated Medicare Drug information or they have the correct order of liability to pay claims correctly.
  • Set Medicare Part D Order of Liability in the Other Party Liability system.
  • Help gather information to create SOP’s within the new area of Medicare Part D.
  • Verify the member has Medicare listed on the Coordination of Benefits system and the Health Order of Liability is correct.
  • Call 1-800 Medicare to make sure we have updated Medicare Health information or they have the correct order of liability to pay claims correctly.
  • Contact Account Group Representative with in BCBSFL if any missing information is needed to complete the Medicare Payment Demand.
  • Review MHS and Diamond system for claims previously processed compared to the Demand information.
  • Manual keying and processing American Medical Association and UB92 claims into the MHS and the Diamond systems while calculating interest needed to pay CMS directly.
  • Update the MPD database with correct information submitted to me from the other representatives.
  • Suggest changes on the layout of the MPD data base.
  • Contact providers and subscribers to inquire about accidents or possibility of other insurance
  • Educate the members and providers
  • Coordinate benefits with other carriers while adhering to State and Federal guidelines.
  • Utilize Medicare and More guidelines to coordinate benefits.
  • Process claims through the Diamond and Quest systems for the OPL department.
  • Retrieve, researching and distributing faxes from the OPL Utilization Management Mailbox.
  • Actively saving BCBSF customers money by keeping premiums lower through accurate and timely processing
  • Process SUB II letters for other insurance information or accident information.
  • Process suspended claims while verifying system updates to the OCL with high attention to detail.
  • Coordinate benefits with other carriers according to State and Federal guidelines for the IMS group and direct pay policies.
  • Review claim history for correct coordination of benefits with other insurance companies.
  • Corporate Initiative Project to Increase Suspense Automation by 10%.
  • Developed test conditions, test scripts, and perform system testing, based on functional design with data requirements.
  • Developed a flowchart of the Control File Inquiry Screen to add changes to the ADS system.
  • Add and change Procedure Codes for 2001 (HCPCS) to Contract Benefit files.
  • Met with SME’s on changes to system involving Benefit files.
  • Request and analyze SAS’s for project information to implement changes to system.
  • Provided technical/analytical support to Front End Services Leadership Team.
  • Identified, developed, recommended and implemented process improvements in order to meet goals and objectives.
  • Focused on accurate and timely research, collection, analysis, making recommendations to manage inventories, design or improve process of workflow, system modification/enhancements.
  • SOP Development for Front End Services detail processing.
  • Examine PI requests and correct system problems.
  • Update manuals for Front End Services manual proc