Annetricia Navaratne
Ellicott City
Summary
Detail-oriented Disability Processing Specialist with expertise in quality review and data accuracy. Proven ability to mentor teams and enhance processes, driving consistently favorable outcomes in complex case adjudication.
Overview
24
24
years of professional experience
Work History
Disability Processing Specialist
Social Security Administration Headquarters
07.2014 - Current
- Analyze , review , and adjudicate initial level, reconsideration level and hearing level cases receiving in disability processing branch. Currently handling CDRS (Continuing Disability Reviews).
- Deal with DCO components, DDSs, Field Offices (FO), medical sources, attorneys, doctors, claimants, and other related professionals to obtain necessary information. Answer their inquiries according to policies
- Uses variety of disability programs and applications to maintain accurate determination.
- Participated in OHO Decision Writing (DW) project for fully favorable ALJ decisions in OHO (from November 2017 – July 2018). Very sensitive information to ALJs. Used FIT, CPMS, E view, and EBB.
- Mentor others in using systems such as MIDAS, E CAT, MS Office, OccuBrowse. E view, ODP case review tool, DCPS, IMAGEN, ASC etc... to process cases until adjudication (on the job training/mentoring). Prepared material for training/mentoring.
- Participate in work groups to assist and advise with policies, quality, and workloads.
- Perform presentations in DPB orientations to new employees including upper-level management.
- Mentor reassigned employees from different departments to learn the disability case adjudication process , reviewed their work in accordance with relevant policies. in FDDD/ Risk and Quality/DCR.
- Maintain high level of customer service, interpersonal skills, decisiveness, better public service motivation, and resilience while performing the above duties.
Benefit Authorizer
Social Security Administration Headquarters
07.2007 - 07.2014
- Made final determinations on the full range of post-adjudicative actions, entitlement, and non- entitlement to benefits, continuing entitlement to benefits, and the payment amounts.
- Researched applicable laws, policies, and procedures to make eligibility determinations and process claims.
- Reviewed prior decisions to determine if the claims need to be reevaluated, corrected, or adjusted due to additional information or evidence
- Adjusted established benefits and make payments. Initiate, receive and respond to telephone and written inquiries to resolve issues or discrepancies and explain or obtain information pertaining to aspects of appropriate titles of the Social Security Act.
- Dealt with all attorney inquiries with working knowledge of the laws, regulations, policies, and procedures pertaining to the full range of post adjudicative issues under the appropriate title of the Social Security Act. Demonstrated higher level of listening and communications skills when dealing with all parties.
- Used various SSA automated systems such as POMS, PHUS, ORS, PCACS, RPS, DMS, POS and Policy net…etc. to research and compile the information and evidence required to process the claims.
- Mentored new hires and reviewed their work for accuracy according to the relevant SSA policies.
Supervisory Medical Billing/Health Insurance Specialist
Financial Health Strategies LTD
03.2006 - 05.2007
- Researched applicable disability laws, policies, and procedures to make benefit eligibility determinations before forwarding to insurance companies. Assigned work to the group of employees.
- Supervised /mentored group of employees monitored and reviewed their work for accuracy and submitted performance reviews.
- Participated in meetings with insurance company leadership related to the workload and resolved case matters.
- Worked closely with the doctors, lawyers, and hospitals to ensure proper medical evidence is in file to submit to insurance companies. (Used Blue Book).
- Analyzed medical evidence according to the medical, vocational, rehabilitative terminology and wrote legally defensive decisions on medical claims to prove eligibility.
- Participated in work groups that gathered and analyzed data for proper claims processing.
Lead Claims Representative
Robert Home Medical
11.2001 - 09.2005
- Interviewed Disable persons to verify their requirements for necessary medical equipment and properly documented the information. Compared and analyzed the information according to medical terms and findings, causes of disease, treatment methods. Applied company laws, regulations, policies, and other criteria to determine medical necessity for the company medical equipment.
- Processed disability insurance claims with numerous health insurance companies to obtain authorizations & reimbursements for durable medical equipment; confirmed and verified medical necessity information with physicians; forwarded information to insurance companies for authorizations; data entry and maintenance on billing claims and patient accounts; communicated with customers regarding billing adjustments. In addition, responded to insurance carrier, and physician inquiries; prepared financial schedules and supporting entries on accounts receivable, collection, and debt collection activities; reconcile accounts receivable; and re-submitted claims as required.
- Reviewed claims for accuracy, gave feedback for the reps.
- Assigned work for the employees. Attended meetings.
Education
Master of Science - Management
Strayer University
Rockville, MDBachelor of Science - Business/ Commerce Administration Honors
University Of Kelaniya
Colombo Sri Lanka Skills
- Quality Review/Verifying data accuracy
- Analytical Thinking
- Leadership
- Communication
- Adaptability
- Attention to Detail
Accomplishments
- Office of Risk And Quality
Precision Path mentor for reassigned employees.
Achieved highest accuracy levels by completing
variety of disability cases with accuracy and efficiency.
- Office of Hearing Operations :
Successfully completed Decision writing project.
Timeline
Disability Processing Specialist
Social Security Administration Headquarters
07.2014 - Current
Benefit Authorizer
Social Security Administration Headquarters
07.2007 - 07.2014
Supervisory Medical Billing/Health Insurance Specialist
Financial Health Strategies LTD
03.2006 - 05.2007
Lead Claims Representative
Robert Home Medical
11.2001 - 09.2005
Master of Science - Management
Strayer University
Bachelor of Science - Business/ Commerce Administration Honors
University Of Kelaniya
Recognition of Contribution for the consecutive 12 years.
Please see SSA 45 for the details.