Mark Edren Toledo

About Mark

3+ years of experience supporting providers with benefits and eligibility, claims and appeals processing, and credentialing applications.

Skills

Experience

• • Verify and explain patient dental plan benefits and eligibility to healthcare provider.
• • Provide claim and prior statuses, providing explanation for claim denials, and initiating requests for reprocessing and reconsideration.
• • Managed the filing of dental appeals, tracked appeal progres, and dispatched resolution correspondence to dental offices via fax and email.
• • Facilitated providers through the credentialing process, including CAQH application, verifying provider network status, and submitting requests for fee adjustment.
• • Interpret EOB to providers and transmit EOB and EOP to provider offices.