Customer Service Medical
Resume:
Jennifer L. Leonard-Nabors
Tampa, Florida 33615
Data Entry, 10 key by touch, (aplha numeric) – 14,000 ksph
Software: Facets, Amps, CSC, MIH, Amisys, Windows Excel, Access, Diamond, Sidewinder, Crystal Report Writing, HSS, Perot Audit Tool, SAS, CRMS, Payment Optimizer and QMACS
Excellent organizational and management skills.
Very thorough and meticulous regarding accuracy and protocol.
Vast knowledge of various state and federal mandates, laws, and guidelines pertinent to the insurance industry
Extensive experience in researching and investigating questionable claims submissions.
Knowledge of ICD-9, CPT, Revenue and HCPCS codes
CCI edits
Medicare/Medicaid Guidelines/HMO/POS/PPO/INDEMNITY Plans
EDUCATION:
Associates Degree in Paralegal Studies, Tampa College
CCP Certification
PCS Certification
CPC Certification
CPC-P Certification
Paralegal
AAPC Member
ACMCS Member
NHCAA Member
ACMCA BOARD MEMBER
EMPLOYMENT HISTORY:
September 2012 – April 2013
Remote HCC Coding Analyst Auditor
Data Driven Delivery Systems
Peformed HCC coding reviews/auditing/trained new hires
March 2011 – September 2012
Remote HCC Contractor
Performed Coding/Auditing functions for several companies listed below.
Outcomes
Your Home Advantage
CSI Health (client – Optum formerly known as Ingenix- UHC)
2000 – March 2011
WellCare Health Plans Inc.
2007 – March 2011
Sr Medical Coding Specialist, CCP,CPC,PCS,CPC-P
Performed chart audits ICD-9, CPT, HCPCS to ensure proper RAPS coding relative to HCC scores for CMS submission
Educated field coders/physicians as needed
Interviewed potential candidates, trained new hires
Coder/Auditor Consultant for Docucoders Inc.
2005 - 2007
SIU Sr Fraud Investigator, CCP,CPC,PCS,CPC-P
Perform investigations from both internal and external referrals
Work closely with the Regulatory Compliance and the Legal Departments to ensure all applicable statutes and fraud plan guidelines are being adhered to
Knowledge of all Reporting Requirements for all states
Assumed Lead position over the Payment Optimizer team
Content Manager for the SIU Sharepoint Website
Possess strong interdepartmental communications
Edited several Policies and Procedures for the SIU
Provided Awareness Training to departments within the organization
Successful negotiations for settlements in a timely manner
Audited medical records to substantiate claims submittals relative to ICD-9/Cpt coding
2002 – 2005
Lead Quality Auditor
Audited claims for both professional and institutional for all Medicaid, Medicare product lines
Audited configuration of contracts within the Diamond system for all Medicaid, Medicare product lines
Coordinated claims and configuration testing for the Harmony conversion
Trained claims personnel on the QMACS system
Developed and maintained Audit Policy and Procedures
Provided associates with continuing education
2000 – 2002
Processor/Auditor
Processed and audited claim for all Medicaid, Medicare product lines
Performed auditing functions for the Accounting Department and claims
Assisted with HEDIS reporting and external audits (DOH)
Worked on Special Provider Projects and Fee Schedules
Trained new hires on the claims process through the Diamond System
Claims Examiner processed claims both manual and electronic for all lines of business including pre-existing conditions and exclusions
1998 to 1999
The Legal Registry
Client – Law Firm of Wilkes, Gardner and Shaheen.
Duties: Paralegal
Claims Service Resource Group (Perot)
Client: Amerigroup /Custom– Claims Examiner Service processed claims both manual and electronic for all lines of business including pre-existing conditions and exclusions.
Client: A.S.I. Inc.- Claims Examiner /Auditor/Customer processed claims both manual and electronic for all lines of business including pre-existing conditions and exclusions.
Client: AVMed - Claims Examiner/Auditor/Customer Service processed claims both manual and electronic for all lines of business including pre-existing conditions and exclusions
Client: Blue Cross Blue Shield - Claims Examiner /Customer Service processed claims both manual and electronic for all lines of business including pre-existing conditions and exclusions
1996 to 1998
Physicians Healthcare Plans, Tampa, FL
Claims Examiner/Customer Service /Handled Priority Adjustments/ processed claims both manual and electronic for all lines of business including pre-existing conditions and exclusions
Paralegal.
Claims Service Resource Group (Perot), Tampa, FL
Client: Blue Cross Blue Shield - Claims Examiner/Customer Service Hospital Coordinator processed manual and electronic claims submissions for all lines of business including but not limited to pre-existing conditions and exclusions.
1988 to 1996
National Insurance Services, Tampa, FL
Claims Examiner/Customer Service/Paralegal
Supervised ten people in Government and Compliance Department
REFERENCES: Vincia Francis Mgr Medical Economics 301-***-**** Wellcare
Keicia Cornwall Sr Medical Coding Specialist 813-***-**** Wellcare
Michelle Pate Sr Medical Coding Specialist 813-***-**** Humana
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