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Expertise In: Family Practice,
Experience : 23
Specialty : Family Practice,
Location : GardenGrove,CA
Description :

THUHONG NGUYEN is a dynamic, skilled, and highly organized individual with 23 years work experience in managed care industry looking for a challenging and fulfilling work place where skills and experience will prove to be a valuable contribution to the office work force.


  • Proficiency with internal re-pricing user manuals, AMA medical/data resources, RBRVS, RVS, CPT, UCR, DRG, HCPCS and ICD-9.
  • Computer proficiency in MS Word, Excel, PowerPoint, Outlook and Windows operating systems
  • Familiar with EDI, e-Repricer, e-Provider, FS Browser and HEAT.
  • Typing speed: 50wpm;


  • Research, analyze and resolve claim appeals from clients, patients and providers through the effective use of provided contract rates/fee schedule.
  • Consider products and contract associations as pertaining to state specific legislation, including discussion with leased network affiliates and regional network development colleagues to bring claim dispute to 100% resolution.
  • Compile correspondences to clients, including use of form letters as well as compose issues for specific claims.
  • Performed random audits on internal and external processors in order to ensure compliance.
  • Compile correspondences to clients, including the use of form letters as well as compose issues for specific claims.
  • Train internal and external staff on departmental policies and procedures.
  • Managed re-pricing and adjusting of facility and professional claims.
  • Electronic processing of various claim types for client identification and provider matching.
  • Reviewed medical claims for level of service, evaluating medical-legal reports and surgery charges for appropriateness.
  • Data entry of medical and non-medical claims according to client specific and state guidelines.

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