Honor Society® member
Meki Woods
Managed Care Contract Specialist at •Supports statistical integrity of the Central Business Office, Physician Practice Support, and Corporate units through quality assurance and effective reconciliation of data discrepancies. •Maintain accountability of practice management system (Athena) including accuracy and validation of contract language, and pricing. •Build, load, and optimize managed care fee schedules into the revenue cycle system managed by PPS
- Healthcare Law
- Class of 2022
- Smyrna, Tennessee
Member since December 2021
Education
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University of Oklahoma College of Law
healthcare law
2021 – 2022
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University of Alabama at Birmingham
Healthcare Management
2001 – 2007
Goals and interests
- Career goal
I have a Bachelor of Science in Healthcare Management earned at The University of Alabama @ Birmingham, I have worked in Health Administration since 2007 in various roles for multiple organizations including Blue Cross and Blue Shield of Alabama, Veterans Health Administration, Optum, and currently with Community Health Systems. Upon graduation, it is my goal to move into a consulting and compliance role.
- Graduate school interests
I am currently enrolled at the University of Oklahoma College of Law, pursuing a Master of Legal Studies in Healthcare Law.
- Outside the classroom
I enjoy the outdoors; hiking, canoeing, nature walks, the beach, traveling, and volunteering,
Experience
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Managed Care Contract Specialist
•Supports statistical integrity of the Central Business Office, Physician Practice Support, and Corporate units through quality assurance and effective reconciliation of data discrepancies. •Maintain accountability of practice management system (Athena) including accuracy and validation of contract language, and pricing. •Build, load, and optimize managed care fee schedules into the revenue cycle system managed by PPS
Jan 2021 – Dec 2022
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Production Auditor
•Ensured adherence to state and federal regulations, reimbursement policies, and contract compliance while assisting in recovery and resolution for all lines of business, health plans, commercial customers, and government entities. •Reviewed, identified, and validated claim overpayments, including, but not limited to duplicate payments, contract compliance, eligibility, and coordination of benefits. •Continuously exceeded monthly goals upwards of $375,000 in identified overpayments for assigned clients.
Jul 2019 – May 2020
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Medical Reimbursement Specialist
•Leveraged account management experience to reconstruct incomplete files, track procedural processing, and gather data to resolve a variety of account discrepancies. •Analyzed accounts receivable records to verify accuracy of figures based on agency regulations, policies, Federal laws, and directives for 12 regions. •Managed all reimbursable billing activities including professional and facility services, sharing agreements, Medicare, and pharmacy billing. •Reviewed third-party payer remittance statements and accounts receivable records to make a recovery determination.
May 2018 – Jun 2019
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leader in training
•Promoted into Facilitator role after extensive training and demonstrated success in previous entry-level positions of Customer Service Specialist and Claims Analyst. •Researched and designed exercises and activities (i.e., Bob Pike) to support and enhance the adult learning experience. •Developed classroom curricula for multiple lines of business (i.e., Duplicates, Coordination of Benefits) through collaboration with department managers to meet the business needs of the Claims Department. •Managed classroom training, coaching, and development of new hires for a successful transition into the role of Inquiry Claims Analyst. •Maintained and updated the online course content necessary for onboarding, professional development, and compliance training.
Jun 2017 – May 2018
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Quality Analyst
•Utilized experience gained as a tri-trained claims analyst to quickly identify and resolve error trends, which encompassed processing of claims held in the BCBS of AL databadr as well as claims/inquiries for that of ITS (BCBS Association and sister plans). •Analyzed stop tables, suspense history, and error codes to isolate discrepancies preventing accurate first-pass adjudication of claims. •Identified, and provide solutions to error trends hardcoded into the automated system and/or the incorrect manual processing of claims. •Increased the accuracy, productivity, and efficient adjudication of claim adjustments by providing detailed feedback and root cause of identified errors.
Jan 2017 – Jun 2017
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Claims & Inquiry Adjudication Analyst
•Utilized developed benefit knowledge to exceed goal metrics for resolution of claims pending, denied, and/or incorrect adjudication and close inquiries. •Researched inquiries from customer service, medical providers, employer groups, Third Party Administrators, Blue Cross Blue Shield plans (ITS), and internal departments for resolution of claims. •Analyzed claim suspensions and denials to identify root cause. •Accurately reprocessed facility, professional, drug, and ancillary claims for Regular business, ITS Home, ITS, and ITS Host.
Oct 2012 – Dec 2016
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Customer Relations Specialist
•Utilized development of interpersonal skills to provide an exceptional customer experience to attract and retain subscribers. •Became a subject matter expert in reading and understanding enrollment agreements, benefit matrices, and explanation of benefits. •Communicated by phone with members, medical providers, other insurance plans, third-party administrators, and/or government agencies regarding insurance coverage. •Maintained working knowledge of medical, dental, vision, pharmacy, and long-term care insurance contracts, and benefit determination. •Established positive customer encounters through the resolution of conflict surrounding claims, benefit eligibility, payment of copays, deductibles, out-of-pocket, and/or premiums. •Utilized HIPAA rules to maintain sensitive and confidential information of members and providers.
Aug 2007 – Oct 2012
Languages
- English (US) Advanced
