Charity A. Jones

ady9x5@r.postjobfree.com

601-***-****

QUALIFICATIONS

• 6+ years’ experience in Human Resource Management with an emphasis on career development and recruitment.

• 10+ years management, and supervisory experience

• Experienced with career portals, interviewing, workforce preparation, and job placement

• 5+ years experience in Medical Billing and Claims Follow Up EDUCATION

M.S Leadership (Concentration: Human Resources), Belhaven University, Jackson, MS B.S Business Administration (Minor: Social Entrepreneurship, Sterling College, Sterling, KS WORK RELATED EXPERIENCE

7/2022-Present. Baptist Memorial Healthcare,

Position: Senior Claims Specialist (Team Lead) Remote/Hybrid Jackson, MS. 601-***-****

Responsibilities:

Supervise the operation of the claims of our clients, Medicare Advantage; to monitor colleagues’ workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Supervises the claims team and/or several (minimum four) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit. Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office. Compiles reviews and analyzes management reports and takes appropriate action. Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards. Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal. Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner. Monitors and maintains High Dollar of claims or questionable claims and sensitive claims as determined by client. Maintains contact with the client on claims and provider reps to promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written disputes of specific claims as requested by client. Assures that direct reports are properly licensed in the jurisdictions serviced. Ensures claims files are coded correctly and adequate documentation is made by claims colleagues. Performs other duties as assigned. Supports the organization’s quality program(s)

SUPERVISORY RESPONSIBILITIES

• Administers company personnel policies in all areas and follows company staffing standards and training recommendations

• Establishes colleague performance development plans; conducts colleague performance discussions

• Provides support, guidance, leadership and motivation to promote maximum performance 8/2021-6/2022 Vestra RCM, Magee, MS 601-***-****

Position: Medical Biller Specialist/ Medicare and HMO Claims Specialist Responsibilities:

Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form (all Payers), Reviewing remittance advice forms to verify proper reimbursement and to make adjustments as necessary, analyzing patient records and determining the legitimacy of treatment, diagnostic testing, admissions. Process billing and follow-up for third party billing, Consulting with claims processors at third party payer companies regarding disputes/denied claims and follow up on all bills not processed within usual claim period, Verify patient benefits eligibility and coverage. Look up ICD 9 diagnosis and CPT treatment codes from online service or using traditional coding references, Follows HIPAA guidelines in handling patient information. Daily communication with Medicare and HMO’s to address claim resolution and rejections. Completed all 2ndary filings including Medicaid Crossover.

Billing system used: SSI, DDE, Novitasphere, Availity and other Insurance portals.

Other Duties: Trained new employees on systems and developed billing process with leadership, produce daily Business Office Summaries, Weekly and end of month Accounts Receivable Reports including denial management

11/2019-8/2021 Kindred at Home, Magee, MS

Position: Administrative Specialist/Human Resources Designee Responsibilities: Process HR related documentation, maintain personnel files, and assist with new employee orientation. Manage and process all accounts payable including routing to appropriate corporate department as needed. Receive referrals from physicians, facilities and staff and enter referral in Homecare Homebase (HCHB). Clearly identify who called in the referral. Ensure all demographic information is accurate on the referral form based on eligibility (Medicare and non-Medicare requirements). Enter Non-Admit information into HCHB with details in coordination notes if no visit was made. Communicates Non-Admit status to referral sources and/or Sales Managers along with the reason for Non-Admission.

4/2011-11/19 Lighthouse Community Development, Mendenhall, MS Position: Executive Director

Responsibilities: Assure that the organization has a long-range strategy which achieves its mission, and toward which it makes consistent and timely progress. Provide leadership in developing program, organizational and financial plans with the Board of Directors and staff, and carry out plans and policies authorized by the board. Maintain official records and documents, and ensure compliance with federal, state and local regulations. 10/2013 – 09/17 Youth Villages, Ridgeland, Mississippi Position: Regional Staff Recruiter

Responsibilities: Manage program staffing for three programs across Mississippi. Maintain client relations with companies throughout the State of Mississippi, hire, interview, and recruit individuals for the mental health industry, work with colleges, and universities regarding job opportunities, assist students with employment process, advertise, and conduct job fairs. Identify recruiting trends and growth areas and consult with leadership to meet business planning goals.

6/2010-10/2013 Pioneer Health Services

Position: Medical Insurance Biller/Claims Specialist, Responsibilities: Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper UB04 and/or CMS-1500 form, reviewing remittance advice forms to verify proper reimbursement and to make adjustments as necessary, Analyzing patient records and determining the legitimacy of treatment, diagnostic testing, admissions, Processing billing and follow-up for third party billing, Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims, perform “soft” collections for patient past due accounts, maintain strict confidence of all patient accounts and complies with all company policies and HIPPA, produce weekly and end of month Accounts Receivable Reports including denial management, performs other jobs and/or duties as requested by supervisor.

References upon request

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