Deborah Walker

Responsible for overall provider and facility education, including on-site and virtual visits, and audits of contract/demographic information. Identifies information/education needs of providers and facilities, and provides input into decisions regarding enrolling/terminating providers.

Responsible for quality reviews of processed claims, targeted reviews, adjustments, and special projects. Performed statistical programming, data accuracy, and quality checks for clinical study databases, and assisted with data management activities.

Prepared and facilitated member appeals, complaints, and grievances, and investigated and adjudicated complex claim requests. Collaborated with Department Heads to discuss guidelines, policy contract language, and department process and standards.

Reviewed and researched accidents and trauma leads to determine pursuit, and assisted IHCP Members in understanding the process of resolution for liability cases. Negotiated with insurance companies and attorneys to maximize subrogation recovery and reach settlement agreements.

Documented results of Member, Provider, Dental, and Pharmacy complaints, appeals, and disputes, and prepared written case summaries for adverse determinations. Coordinated and facilitated review hearings and Internal Appeal Committee meetings.

Completed a Bachelor of Science degree with a focus on Business Management. Gained comprehensive knowledge in various aspects of business operations and strategic planning.