Samantha Savage

Processed commercial medical claims accurately within turnaround-time standards, reviewing completeness, coding accuracy, and benefit application. Resolved discrepancies using QNXT and internal audit tools while coordinating with providers for missing documentation and maintaining 115+ claims/day productivity.

Registered patients onsite by verifying insurance and scheduling appointments while handling Medicare forms and other required signatures. Ensured EMTALA compliance, obtained pre-certifications, completed HIPAA forms, managed patient ID bands, and calculated/collected copayments and deductibles.

Performed claim research, coding review, and benefit interpretation for the commercial line of business. Managed complex claim corrections and coordinated documentation follow-up.

Processed commercial and Medicaid claims across multiple lines of business and resolved pended claims by reviewing benefits and coding discrepancies. Conducted reconsiderations and adjustments and drafted timely, compliant determination letters based on clinical record and policy reviews.

Coordinated scheduling, referrals, and pre-authorizations and handled patient inquiries. Documented encounters in Epic, prepared clinical summaries, and managed provider inbox tasks.

Reviewed, entered, and adjudicated TRICARE and commercial medical claims while verifying coding consistency (CPT/ICD-10/HCPCS) with supporting documentation. Met 99% accuracy on monthly quality audits.

Processed HealthNet/Centene commercial medical claims by evaluating coding, eligibility, benefit structure, and provider contracts. Corrected denials and reprocessed adjusted claims while maintaining consistent output of 110–125 claims/day and supporting complex cases with supervisors.

Processed medical claims, verifying insurance coverage, benefits, and authorizations for the commercial line of business. Registered patients, collected copays, and supported patient flow with accurate front-end documentation.

Completed studies in Sociology at California State University, Northridge from 2001 to 2003.

Earned a high school diploma from Inglewood High School from 1997 to 2001.