Healthcare Administration

Adella Jackson

Highly-motivated rising professional with a solid health care administration education coupled with hands on experience in health insurance benefit enrollment, insurance verification and billing. Excellent qualifications in health care delivery human resources, communication, healthcare management, risk management, organizational behavior and customer service.

Excel in grasping new ideas and quickly applying them to all learning aspects of the organization’s operation. Creative problem solving techniques, can successfully manage multiple priorities, perform well under pressure and meet deadlines in a fast-paced environment. Easily accepts leadership roles with the ability to teach motivate and inspire team members.

Areas of Expertise

Good communication, written and interpersonal skills- Able to work in a team or independently-Proficient with Medical terminology, Microsoft Office Word, Excel, Outlook, Access, PowerPoint Visio, MediSOFT, EMR, IDX, Siebel, Cisco and project management- Excellent knowledge of office equipment- Excellent typing skills- Able to adapt to changing software program applications- Good ability to work with diverse groups, all levels of internal management, staff, and customers.

Education

University of Phoenix-Phoenix

BS in Healthcare Administration Health Information Systems (March, 2012)

Major: Health Administration with a concentration in Health Information Systems

Ashworth College

AS in Health Care Management (June, 2008)

Houston Community College

Certificate of completion in Medical Coding Transcription (August, 2008)

TWIC (Transportation Worker Identification Credential) card /TSA

Sava Senior Care- Managed Care Coordinator, Houston, Texas, 4/13/2015-Present

Responsible for receiving referrals, and making sure authorization is obtained for patients.

Support the facility in locating insurance authorization.

Insurance Verification (Skilled nursing facility).

Use of fax, copier and scanner daily during the authorization process.

Understanding IV medications and high cost drugs.

Negotiation of rates from the insurance company for patient admission to the facility.

Analyzing and using ICD 10 for coding cases.

Experienced in using a multi-line phone system and computer daily.

Entering authorization and referral information in company software program.

Very proficient in obtaining authorization with excellent attendance.

Provides excellent customer service with the insurance company and facility.

Parallon (Shared service center for HCA system) Underpayment Analyst, Houston, Texas, 05/19/2014-4/6/2015

Work on accounts that are under paid from commercial insurance companies.

Call payers to inquire about accounts that have been appealed to obtain claim status.

Review contracts for proper reimbursement.

Send appeals in an attempt to collect recovery.

Trouble shoot accounts to determine if indeed the account is underpaid and what steps need to be taken to recuperate funds.

Discuss codes that have been bundled, or have denied for any reason, once that is established information is forwarded for rebill.

Data entry

Coventry Health Care/Aetna- Customer Communication Representative, Texas-06/2013-06/1/2014

Handle inquiry calls for Medicaid recipients in Kentucky

Make changes for members and providers, and send Medicaid cards and materials as requested by customers.

Solve problems as it pertains to claim status, and pre-authorizations.

Fax EOB’s and other pertinent documentation as it relates to the claim.

Explain COB’s with Medicare, Medicaid and commercial insurance providers.

Detailed explanations of denied claims with providers.

Problem solving in all aspects as it affects the member’s case with Medicaid and claims.

Explanation of the appeals process as it relates to the denied claims.

Customer Communication Representative- Mercer- Houston, Texas-09/2008-01/2010-Temporary Assignment

Inbound call center.

Benefit Enrollment.

Used a multi-line phone system daily.

Daily use of Outlook for emails and other activities.

Spoke to customers about their health insurance benefits.

Counseled customers on health insurance, according to need.

Benefit enrollment.

Daily use of Microsoft office.

Problem solved.

References available upon request.

Contact this candidate