Adrienne M. Jarmon
Hampton,VA
Summary
Results-driven healthcare administration professional with over 15 years of experience in billing and coding, revenue cycle management, and specialty claims processing. Expertise in electronic health records (EHR) management while adhering to HIPAA guidelines, combined with a solid understanding of medical terminology relevant to ICD-10 and CPT/HCPCS coding. Exceptional ability to cultivate and sustain relationships across all levels of the billing and claims process, ensuring meticulous documentation and resolution of claims. Proven track record in auditing claims for compliance with company policies, identifying discrepancies, and enhancing the accuracy and efficiency of claims processing through strong data analysis skills and keen attention to detail.
Overview
15
15
years of professional experience
Work History
Claims Auditor(Performance Measurement Specialist)
Sentara Health Plan
05.2024 - Current
- Conduct comprehensive audits of adjudicated claims, including inpatient, outpatient, ambulatory surgery, durable medical equipment and specialty claims to ensure accurate processing CMS guidelines and Sentara's policies and procedures.
- Analyze adjudicated claims for accuracy and completeness, identifying discrepancies and potential fraud per CMS guidelines.
- Collaborate with claims processing teams to streamline workflows and enhance operational efficiency.
Group Benefits Analyst III
Sentara Health Plan
11.2018 - 05.2024
- Skilled in the adjudication and processing of specialty claims, including inpatient, outpatient, ambulatory surgery, and durable medical equipment.
- Proficient in identifying and resolving claims issues based on Sentara Health Plan policies, and guidelines ensuring claims are processed according to established quality and production standards.
- Communicated with Clinical, System Administration, Enrollment, and Recovery departments to ensure validity of information in member's EHR, including but not limited to CPT codes, ICD-10, COB, and provider network status.
- Led training sessions for GBA's on processing of inpatient claims, creating training materials to assist based on my extensive knowledge of the subject.
- Consistently exceeded claims processing goals as set forth by claims department.
- Yearly continuing education training for HIPAA, Diversity Training, Conflict Resolution, and Medical Terminology.
Revenue Cycle Specialist
Pathways by Molina
03.2016 - 05.2018
- Collaborated with the organization's State and Regional Directors to establish an effective revenue cycle process, to streamline front desk and clinical processes, to improve patient satisfaction, as well as increase revenue.
- Analyzed claims denials, identifying root causes to enhance resolution strategies.
- Increased revenue by identifying and resolving billing errors in a timely manner.
- Achieved optimal reimbursement rates by verifying insurance coverage, eligibility, benefits, and authorization prior to service delivery.
- Maximized reimbursements by staying current on payer requirements and maintaining strong relationships with insurance providers.
- Reconciled multiple patient accounts 180 days or more past due. Extensive research identified several billing errors which resulted in the denials and non-payment of claim. Making the necessary corrections resulted in a $200,000 payment resolution within first 90 days in the position.
Refund Specialist
Fairfax Radiological Consultants
11.2010 - 03.2016
- Developed standard operating procedures for refund processing to enhance workflow efficiency.
- Collaborated with billing department to resolve complex refund issues effectively.
- Reviewed and analyzed claims for accuracy, identifying discrepancies in payments.
- Processed patient refund requests efficiently to ensure timely reimbursements.
- Trained new team members on refund protocols and system navigation best practices.
- Led initiatives to streamline the refund process, reducing turnaround time significantly.
- Implemented quality control measures to improve accuracy of processed refunds consistently.
- Provided exceptional customer service, addressing inquiries related to refunds promptly and professionally.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
Education
Associate of Science - Business/Health Services Administration
Strayer University
Fredericksburg, VA01.2018
Skills
- Healthcare Administration
- Account Billing & Reconciliation
- Medical Terminology
- Coding CPT/ICD-10 Codes
- Office Administration
- MS Office Suite
- Analytical Skills
- Organizational skills
- Detail Oriented
- Communication Skills
- Customer Service
Timeline
Claims Auditor(Performance Measurement Specialist)
Sentara Health Plan
05.2024 - Current
Group Benefits Analyst III
Sentara Health Plan
11.2018 - 05.2024
Revenue Cycle Specialist
Pathways by Molina
03.2016 - 05.2018
Refund Specialist
Fairfax Radiological Consultants
11.2010 - 03.2016
Associate of Science - Business/Health Services Administration
Strayer University