Cayla Benham

• Ensure benefits are configured in enterprise system for new and updated benefit packages.
• Respond to internal inquiries and system issues in a timely manner concerning member's benefits or authorizations.
• Create documentation for new processes or implementation of projects.
• Collaborate with developers to improve system processes.
• Lead efforts on implementation projects, working with outside vendors and development team to implement new file processes for authorizations.
• Work with outside vendors to create solutions for any authorization issues.
• Mentor and provide guidance to other team members concerning daily job duties and the flow of authorizations.

• ·Create test plans for corresponding projects and test to ensure overall accuracy and function (Marketwrite).
• ·Complete tasks in a timely manner that are assigned in TFS by insuring Issues have been corrected.
• Review XML error report, SBC error report, Dental Certificate Email report, and Metallic with No Decision Date report to ensure errors are true errors and corrected.

Processed in-state standard claims, adjustment claims, corrected claims, and walkthrough claims for Exchange and Health Advantage with accuracy by researching in company systems and documentation.

Responsible for the completion of queues and monthly spreadsheets, and worked with a team to update procedural documentation.

Screened patients for eligibility of Medicaid or hospital financial assistance. Filed Medicaid applications with DHS county offices and followed up until determination was made. Documented patient screenings, any payments, insurance coverage, and follow up work.