This month we are focusing on the MediView Claims Department.  Shirley is one the 14 claims analysts who work at MediView.  Each of the claims analysts work on specific lines of business, since the benefits and providers are different for each line.  This enables the analysts to become very familiar with what should be paid, what should be denied, and recognize when there are provider billing trends that change.  Shirley has been with MediView since 2002 and works on the Seton CHIP line of business.  Approximately 75% of the claims she processes are electronic, which allows her to work from her home in Buda 3 days a week.  Her typical day starts with logging in and reviewing the queue of claims to be processed, working any pended claims, paying the claims in the queue that day, sending out-of-network claims for repricing, and reviewing reports of her daily work.  She reviews for timely filing, high dollar claims needing auditing, and anything out of the ordinary.  On an average day, Shirley will process 200 professional claims.

Prior to MediView, Shirley worked for the Mental Health Network, processing mental health claims.  The way Shirley contributes to MediView’s success is to have worked on the Seton CHIP claims for over 6 years to the point that she is efficient and accurate and able to process a high volume on a regular basis without problems.  Ensuring the providers are paid correctly the first time helps MediView avoid the cost of reprocessing claim errors.

Interesting personal facts about Shirley include:

• Favorite activity – going to the Premier Lady gym; she tries to get there 4 times a week.  And has already lost 20 pounds! Wow!!
• Favorite new activity – learning to swim; she’s graduated to level 3 and plans to keep going.  She also enjoys the Mommy & Me swim classes on Saturdays with her son, Parker.
• Favorite TV shows – Discovery Channel’s Trauma show and A&E’s First 48.