Darrian L. Jones

Palm Bay,FL

Summary

Sought dynamic roles to enhance career trajectory and contribute to organizational success.

years of professional experience

BCBS NC

03.2022 - Current

Conducted thorough reviews and analyses of appeals to uphold compliance with regulatory requirements.
Engaged with cross-functional teams to streamline processes for effective resolution of complex cases.
Created engaging training resources to enhance understanding of appeals processes and policies for new employees.
Developed and implemented strategies to improve precision in appeal resolution processes.

BCBS of North Carolina

09.2014 - 03.2022

Processes admission notifications and/or authorization requests.
Receives and responds to authorization requests from hospitals, physicians, vendors, facilities and members based on timeliness standards. Determines authorization requirements and member eligibility for requested services.
Works as part of a multidisciplinary Health Care Coordination Team; identifies and tasks appropriate health care service delivery for selected patients, providers, procedures, and/or diagnoses.
Works daily queues according to department directives to ensure all payer-specific authorization requirements are met and authorizations successfully obtained while consistently meeting department productivity standards.
Communicates and works with clinical staff to ensure proper entry and delivery of information and authorization requests related to administrative approvals and medical necessity reviews.
Batches documents and records for imaging as required.
Provides quality customer service to all patients and customers through prompt and courteous professional communication.
Effectively utilize and navigate using internal resources to arrive at the right solution for the client e.g. computer systems, online resources, and business partner relationships.
Demonstrates excellent call handling skills, patience and respect with complex and non-complex calls while processing transactions accurately.
Facilitates underwriting and processing of new members during open enrollment and at life events.

Quality Inn (Formerly Holiday Inn Express)

03.2006 - 09.2014

Reviewed front office accounting records for accuracy and, daily, summarizes and compiles information for the hotel’s financial records.
Monitored room revenue, occupancy percentages, and other front office operating statistics.
Prepared a summary of cash, check, and credit card activities, reflecting the hotel’s financial performance for the day.
Updated room charges and room taxes to guest accounts including guest transactions not posted during the day by the front office cashier.
Ran End of day process / Night audit process on the Property management software.

Wake Technical Community College

Raleigh, NC

Managing customer relationships: Providing great service to existing customers and developing a new customer base, monitoring customer satisfaction and service quality, handling feedback from clients, take ownership and responsibility on each call, tolerant and flexible to different situations, and strong verbal and communication skills
Working with others: supervising employees, operating effectively as a leader or member of a team, independence and initiative, communication skills, analysis and problem solving, scheduling and confirming appointments, and quick learning skills