Jevette Moone

Byron, GA *****

adq1rn@r.postjobfree.com

561-***-****

Knowledgeable and dedicated customer service professional with 25 years of experience in the healthcare industry. Proven expertise in insurance products, analyzing documentation, liaising between parties, and handling both routine and complex issues each day. An articulated self- starter, energetic and results-oriented individual who exemplifies passion for leadership, developing relationships, and cultivating partnerships.

Authorized to work in the US for any employer

Work Experience

Provider Complaints Coordinator

AmeriHealth Caritas - Palm Beach Gardens, FL

June 2014 to Present

● Receive, investigate, and respond to providers and their office staff complaints including complaints received through state or federal regulatory agencies

● Assist with ensuring compliance with contractual requirements along with Federal and State Government reporting and regulations

● Assist with the development, update, and maintenance of complaint-appeals policies and procedures

● Maintain compliant and complaint-appeal logs to include all contractual and regulatory required information

● Receive, process, track, and maintain all members, provider and regulatory complaints, and complaint- appeals

● Coordinate applicable internal and external providers to obtain the necessary documentation and information necessary to respond to a complaint or complaint-appeal with providers through the State of Florida Medicaid and Federal regulations

● Serves as a resource to other departments in completing a resolution to provider disputes

● Executes on organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory and standard requirements according to Plan’s policy

● Work successfully and diligently within all levels of the organization Cashiering/Account Clerk

Ocwen Financial Corporation, Inc. - West Palm Beach, FL July 2013 to June 2014

● Experience in research and resolving cashiering inquiries for internal and external customers

● Ensured that 99% of all payoffs were processed and deposited on day of receipt

● Exceeded monthly targets through continuous monitoring of implementing project items 1,000 loans of 12.5% by reviewing previous complaints, analyzing complaint trends, and understanding the scope of complaints as related to cashiering

● Proficient with payments, payoff processing, depositing, and reconciliation of payment and pay off batches

● General accounting knowledge to include experience with general ledgers, credits/debits, and processed transactions

Healthcare Representative

Healthnet Federal Services - Arlington, VA

March 2005 to March 2012

● Provided information to TRICARE providers with regards to the TRICARE program, and specifically the provider network operations

● Conducted briefings for health care providers to educate them about the program and available services

● Performed research of unresolved or complexed issues, compiled necessary information, and forwarded data to appropriate staff members for resolution

● Provided technical replies to providers regarding TRICARE policy, operations, payment coding, claim submission requirements, and fee/payment explanations

● Conducted outbound survey calls and data verifications Healthcare Representative

Sierra Military Health - Andrews AFB, MD

July 2001 to March 2005

● Assisted active-duty personnel, their families, and retirees with scheduling appointments for care in various Military Treatment Facilities (MTF)

● Worked on special projects which required researching information and attending meetings with the MTF commanders and management

● Scheduled civilian appointments and trained co-workers on new procedures and guidelines

● Provided professional and courteous service when receiving incoming calls from beneficiaries

● Served as a team leader in the absence of the manager Medical Billing Specialist

Aetna U.S Healthcare - Greenbelt, MD

January 1999 to July 2001

● Submitted and verified data for medical claims such as Hospital UB92’s and HCFA 1500’s

● Performed troubleshooting procedures for manual correction claim forms (MCL) and referral duplicates

● Trained temporary employees in work related areas and worked special projects upon request by supervisor

Medical Billing Specialist

Singing River Hospital - Gautier, MS

February 1997 to March 1998

● Billed multiple insurance carriers via electronic filing systems as well as manual hard copy

● Coordinated claims with valid revenue codes, healthcare claims forms, dates of service, and adjusted payments to patients’ account

● Performed routine office administration

Office Manager

Marshall Newsome, N.E.T - Warner Robins, GA

July 1995 to February 1997

● Monitored fiscal year expenditures to ensure that the budget funds were properly spent

● Dispatched vehicles to various medical facilities for patients’ assistance

● Processed invoices for accounts payable, prepared memorandums, scheduled appointments, and maintained record and files

Quality Control Resource Agent

Norfolk Southern Railroad - Norfolk, VA

May 1993 to June 1995

● Monitored physical examinations for employees, including hearing and eye examination, and forwarded all physical examination reports to the Occupations Health Nurse for review

● Tracked and monitored medical data and suspensions to coordinate periodic physical examinations per company guidelines.

● Inspected output testing’s using industry-appropriate methods, such as comparing to standards, measuring dimensions, and examining functionality. Education

Some College Courses in Business

Trinity College - Hartford, CT

August 1986 to May 1988

Certification in Data Processing

Computer Processing Institute - East Hartford, CT

May 1984 to December 1984

High school diploma in General Studies

Douglas High School - Montezuma, GA

August 1980 to May 1984

Skills

• Healthcare Representative

• Customer Service Representative

• Quality Control Resource Agent

• Provider Contracts

• Medical Billing Specialist

• Accounts Payable

• Customer Relations

• Call Center Specialist

• Provider Complaints

• Medical Terminology Knowledge

• Debits & Credits

• Project Implementation

• Accounts Receivable

• Accounting

• Account Reconciliation

• Order Entry

• Office Management

• Medical Records

• Insurance Verification

• Bookkeeping

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