Denver Jenkins
Haines City,FL
Summary
Self-motivated Data Analyst offering 10+ years of Medical experience across various industries. Excellent problem- solver, Goal-oriented prioritizing tasks and approaching issues with analytical mindset. Bringing years of experience and demonstrated track record of success. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
16
16
years of professional experience
2
2
Certification
Work History
Provider Data Analyst specialist/PDM
Aetna
Remote
10.2021 - Current
- Analyze and Interpret the Provider Data (demographic and contractual) for all network and non-network providers from multiple sources
- Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings)
- Develops and maintains standards for database integrity, corrective actions, database alignment, and manages communication processes with other departments regarding database improvements
- Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data integrity issues
- Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory
- Performs intake triage and responds to network inquiries, escalates when necessary.
Provider Relations Specialist-Remote
Active Health Management CVS/Aetna
Remote
04.2021 - 09.2021
- Answering questions from doctor's offices about benefit verification, entering claims data for processing, maintaining a good relationship with providers
- Reviewing provider contracts, claims and insurance codes
- Ensuring medical sites comply with state insurance regulations
- Answering questions about insurance claims and requirements.
MEDICAL REVIEW AUDITOR -Remote
Performant Financial Corporation
San Angelo, TX
10.2019 - 04.2021
- Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules
- Document all findings referencing the appropriate policies and rules
- Generate letters articulating audit findings
- Supporting your findings during the appeals process if requested
- Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
- Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits
- Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients
- Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members
- Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines
- Interface with and support the Medical Director and cross train in all clinical departments/areas
- Other duties as required to meet business needs.
Data Entry /Claims Specialist
United States Medical Supply
Doral, FL
07.2015 - 09.2019
- Collecting and digitizing data such as invoices, canceled bills, client information, and financial statements
- Maintaining a detailed and organized storage system to ensure data entries are complete and accurate
- Keeping a record of hard copy data such as invoices, inventory checklists, and other financial documents
- Establishing data entry standards by continually updating filing systems to improve data quality
- Addressing data inconsistencies by working with administrative staff to locate missing data
- Attending to data queries and reporting any major data errors to management
- Adhering to best data management practices and maintaining a high standard of accuracy and efficiency
- Analyze and investigate complicated insurance claims to help prevent fraud
- Resolve claims in a timely manner
- Stay up-to-date on local, state and federal law changes in the insurance field.
Authorization Coordinator
HNI (Health Network One)
Davie, FL
01.2011 - 06.2014
- Served as Customer Service, Authorizations for PT,OT,ST, Referrals,Enrollment, Payment Poster, and Claims, and Provider Relations
- Processed over 50+ authorizations/referrals daily
- Ensure accurate and efficient processing
- Quality Productions/ Standards
- Handle Sunshine, Humana, Amerigroup, Medicaid and Medicare.
Senior Quality Assurance Analyst
Nations Health Service
Sunrise, FL
03.2008 - 12.2010
- Open enrollment, review the current policies and improvise plans to improve upon the existing quality standards monitoring and providing feedback on ways to improve service set by federal guidelines and company policies
- To insure that the HIPAA guidelines are being followed.
Education
Associate Certificate - Medical Billing and Coding
National School of Technology
09.2004
Medical - Medical Assisting
Concord University
11.1991
Skills
- PROFESSIONAL SKILLS
- Microsoft Office
- Windows Proficient
- Inbound/Outbound Calls
- Advance knowledge of healthcare billing, Medical Records Documentation AuditProficient with Microsoft System (including Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Access, and Microsoft Outlook Availity, Medicaid & Medicare system, and Web MD systems (10 years)
- Medical Terminology
- ICD-9
- ICD-10
- Medical Billing
- Medical Records
- CPT Coding
- Anatomy Knowledge
- Medical Office Experience
- Time management
- Microsoft Excel
- Microsoft Word
- Insurance Verification
- ICD Coding
- Clerical Experience
- Data Entry
- Auditing
- Hospital Experience
- Managed Care
- Medical terminology
- HIPAA
- Medical coding
- Epic
- Documentation review
- Anatomy knowledge
- Physiology knowledge
- Clerical experience
- Data collection
- Customer service
- Microsoft Access
- Windows
- Quality assurance
- Research
- Negotiation
- Employment & labor law
- Network management
- Computer networking
- Financial auditing
- Cold calling
- Phone Etiquette
- Intake Experience
- PRMS (2 years)
- NPPES (2 years)
- QNXT (3 years)
- SMART FRONT
- HIPAA Compliance
- Report Generation
- Data Validation
- Data-driven decision-making
- Business Needs Analysis
- Report Writing
- Strong Work Ethic
- Clear and Concise Communication
- Data screening
- Report Preparation
- SQL
- Data Analysis
- Data Interpretation
Certification
- Medical Billing Coding Certification
- Certified Medical Assistant
Additional Information
Medical Records Documentation Auditor, provider claims analysis.
References
References available upon request.
Timeline
Provider Data Analyst specialist/PDM
Aetna
10.2021 - Current
Provider Relations Specialist-Remote
Active Health Management CVS/Aetna
04.2021 - 09.2021
MEDICAL REVIEW AUDITOR -Remote
Performant Financial Corporation
10.2019 - 04.2021
Data Entry /Claims Specialist
United States Medical Supply
07.2015 - 09.2019
Authorization Coordinator
HNI (Health Network One)
01.2011 - 06.2014
Senior Quality Assurance Analyst
Nations Health Service
03.2008 - 12.2010
Associate Certificate - Medical Billing and Coding
National School of Technology
Medical - Medical Assisting
Concord University
- Medical Billing Coding Certification
- Certified Medical Assistant
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