Insurance Supervisor
Resume:
ANGELA C. JONES, M.H.A.
*** ******** ** •Marietta, Georgia • 30064
Cell: 404-***-**** Email: ******.********.*****@*****.***
Summary of Qualifications
Exceptional oral and written communication skills
Excellent interpersonal skills to deal effectively with all business contacts.
Advanced skills in Excel (highly proficient in performing Pivot tables and Vlookups,
Proficient in Microsoft Word, Microsoft Access, Power Point & Outlook
Excellent organizational skills to function effectively under time constraints
Extraordinary ability to give great attention to detail.
Remarkable and effective listening abilities and strong judgment skills.
Strong analytical skills
Experience working with cross-functional teams, root cause analysis and determining solutions
Knowledge of specific account types and billing/AR procedures.
Knowledge of automated general ledger system
Professional Experience
Buck Consultants
Medicare Business Analyst
July 2014-September 2014
●Process Commission Reconciliation and management for Medicare
●Review commission reports from carriers to ensure proper commission payments are received for all confirmed
Medicare enrollments
●Upload (or data enter) commission information to central exchange portal where data from carriers is
incomplete/missing
●Associate commission payments with enrollments and enrollment year
●Reconcile missing/incorrect Medicare enrollments with carrier
● Run reports analyzing commission payments; review timing and amount of payments
●Identify missing/incorrect enrollments
●Update Medicare enrollments and membership records (e.g. deaths and disenrollments)
eLab Clinical Laboratory
Billing & Collections Analyst
June 2013-July 2014
●Managed and secured CLS contracts for practices to be set up to be contracted billed and negotiated pricing.
●Reviewed daily contract service reports for accuracy and compared with EOM invoices.
●Analyzed workflow processes both internal and external to the department to ensure that the revenue cycle and
maximum conversion rate of Medicare/Medicaid pending to Medicare/Medicaid eligible is achieved.
●Prepared ad hoc reports in response to management requests
● Reviewed and analyzed client agreements (e.g., engagement letters, rate agreements, and client guidelines);
●Identified revenue realization opportunities and risks related to client agreements;
●Identified and implemented solutions to reduce significant and/or recurring billing issues
●Monitored, analyzed and reported e-billing rejections;
●Analyzed inventory data, evaluate inventory trends, identify areas for improvement, risk mitigation, and escalation
●Analyzed complex situations and developed applicable and practicable solutions independently.
●Furthered department objectives to collect cash, reconcile past due balances, expedite revenues, and increase
Medicare/Medicaid conversion percentage
●Assured mandatory billing requirements have been met in order to ensure timely and optimal reimbursement. Set up
action/reason codes for outstanding revenue.
●Improved revenue cycle production and efficiency by reviewing and analyzing daily summary reports and workflow
processes as well as recommending changes that will positively impact the Revenue Cycle and meet A/R performance
goals and productivity.
Northside Hospital
Lead Billing/Claims Analyst
October 2012-June 2013
●Contacted insurance companies to follow up on appealed claims.
●Held payors accountable for timely resolution of all claims sent back for reprocessing and all appeals submitted.
●Drafted written letters of appeal on various types of denied claims, utilizing standard letters as well as customized
letters depending on the denial
●Utilized/reviewed account information from all available sources; online data, hard copy reports, referral forms,
UB/HCFA and EOBs to fully discuss condition with the payor via phone, fax, or email.
●Ensured the correct reimbursement rates are being paid per the client contract summaries.
● Reduced bulk of outstanding revenue for Medicare and Medicaid.
● Referred accounts to the appropriate departments for necessary action, i.e. balance transfers, coding review, remit
posting, etc
●Maintained appropriate and accurate system documentation with notes and standard note codes.
●Notified supervisor of payor trends in denied accounts
●Submitted written summary of trends and denials to supervisor on a monthly basis
●Abides by and promotes HIPAA compliance at all times
Cahaba Government Benefits Administrators, LLC
August 2011-October 2012
Medicare Claims Analyst/ Processor
●Assisted Medicare Part A and Part B providers with claim status/ claims processing/claim denials/billing and coding
● Assisted providers with financial overpayments and recovery, voided and reissued checks.
● Reviewed and explained Medicare Change Requests regarding the FISS system to Part A and Part B providers
● Assisted providers with enrolling into Medicare Program and assisted with Revalidation requests
● Worked with Medicare operating programs such as HIMR, MCS, FISS, Mainframe, and Oracle
HIGLAS Accounting System regarding Medicare-specific information pertaining to beneficiaries, claims processing
and benefits explanation.
● Prepared Medicare cost report analysis on monthly basis
● Documented FISS (Part A) process guidelines and explained to providers
● Assisted and informed providers of information regarding updates with the Medicare
Physician Fee Schedule mandated by CMS and participated in weekly trainings.
● Adhered to HIPAA privacy laws and confidentiality standards as governed CMS and by the
Federal government
Alere Healthcare
Insurance Enrollment Specialist
September 2010-August 2011
● Placed outbound calls to participants to get enrolled in benefits program.
● Answered inbound calls on dialer to complete enrollment assessments and/or follow-up assessments.
●Verified eligibility through insurance portal, verified and/or updated contact and insurance information to ensure
accuracy for referrals.
● Provided 24 hour case management services to high-risk participants.
Ellis Hotel, Atlanta, GA
April 2008 - September 2010
Front Office Supervisor
● Supervised the day-to-day operations of the front office operations
● Assisted staff with expediting problem payments (e.g., problems processing credit card payments).
●Followed up with guest regarding satisfaction with guest-related issues.
● Processed all guest check-ins by confirming reservations, assigning room, and issuing and activating room key.
● Processed all payment types such as room charges, cash, checks, debit, or credit.
●Set up accurate accounts for each guest upon check-in (i.e., sharewiths, separate room/tax/incidentals, comp).
● Anticipated sold-out situations and obtain satisfactory alternative accommodations when the property cannot
accommodate guests with reservations.
● Blocked rooms in the computer and identify designated requirements and requests.
● Contacted appropriate individual or department (e.g., Bellperson, Housekeeping) as necessary to resolve guest call,
request, or problem. .
● Assisted management in training, motivating, and coaching employees
Education
Walden University
Masters of Arts in Healthcare Administration, June 2014
Georgia College & State University, Milledgeville GA
Bachelors of Science in Sociology, December 2007
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