SHELIA JUMPER

***** ******** ***** ** *, Magnolia, TX 77355 · 281-***-****

ad4uz1@r.postjobfree.com · https://www.linkedin.com/in/shelia-jumper-81178a97/ ·

Ambitious and motivated Director of Managed Care, with over fifteen years of experience in managed care and a decade of support to Executive Directors and Partners.

Authorized to work in the US for any employer.

EXPERIENCE

JUNE 2021 – CURRENT

DIRECTOR OF MANAGED CARE, ASSURE HOLDINGS CORP

Filed state independent dispute resolutions with the Texas Department of Insurance per TX Senate Bill 234.

Filed arbitrations with the Texas Department of Insurance per TX Senate Bill 234.

Successfully settled and closed over 1000 IDR Requests with the Texas Department of Insurance.

Negotiated Managed Care contracts with Health Plans, to include rates and terms.

Familiar with Fair Health Organization and the third-party fee determination schedules.

Negotiated settlements with Health Plans and third-party payors.

Provider Credentialing and onboarding, CAQH.

Filed Federal independent dispute resolutions and Open Negotiations with Health Plans and Third-Party Vendors.

Familiar with Electronic Remittance of Payment from Health Plans, including remit codes, health plan language, patient benefits, and policy details.

Filed Federal Arbitrations and successfully being awarded over the non-initiating parties.

APRIL 2007 – CURRENT

ADMINISTRATIVE DIRECTOR, PHS HOLDINGS LLC

Supported Chief Executive Officer with daily operations of the company.

Compiled quarterly budget reports and financial spreadsheets for the Executive Team.

Obtained documents, clearances, certificates, and approvals from local, state, and federal

agencies.

Performed initial client assessment and onboarding.

Proficient use in Microsoft Office, QuickBooks Online, Canva, Drop Box and SharePoint.

Assisted with team building initiatives to improve employee morale.

Responsible for all Accounts Receivables/Accounts Payables.

Providing requested P/L, Balance Sheet, and Registers to Executive Team.

1099 Prep and distribution to all Contractors Annually.

Tax preparation and filing.

APRIL 2007 – JUNE 2021

ADMINISTRATIVE DIRECTOR/RCM DIRECTOR, SENTRY NEURO LLC

Submitted electronic/paper claims documentation for timely filing.

Responded to correspondence from insurance companies.

Posted and adjusted payments from insurance companies.

Confidently and adeptly handled claim denials and/or appeals.

Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.

Maintained strict patient and physician confidentiality.

Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.

Reviewed medical records for completeness and filed records in alphabetic and numeric order.

Negotiated managed care contracts with health plans for the best possible reimbursement fee schedules.

Provider credentialing and onboarding, CAQH, NPPES.

Recorded and filed employee benefit, salary, and annual evaluation information.

Reconciled company bank, credit card and line of credit accounts.

Prepared monthly, quarterly, and annual profit and loss statements and balance sheets.

Utilized QuickBooks accounting system to reflect accurate financial records.

EDUCATION

BUSINESS MANAGEMENT, lONESTAR COLLEGE

SKILLS

Medical Billing (12 PLUS YEARS)

Medical Collections (12 PLUS YEARS)

GAAP Principles

QUICKBOOKS (14 PLUS YEARS)

State Arbitration Filing /SB1264

ACTIVITIES

I love to give back to my community as much as possible. I frequently volunteer for the Birdies for Parkinson’s and for the Epilepsy Foundation of America.

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