Donna Jenkins
Jacksonville
Summary
Proven professional with expertise in Medicare appeals process. Skilled in time management and dispute resolution, with a track record of streamlining processes to enhance accuracy and efficiency.
Overview
14
14
years of professional experience
Work History
RA1 , Appeal Specialist, RA2, RA3, Quality Auditor
C2C Solutions
Jacksonville, FL
11.2011 - 11.2025
- Reviewed and analyzed appeals to ensure compliance with regulatory standards.
- Collaborated with cross-functional teams to resolve complex case issues effectively.
- Developed training materials to enhance team understanding of appeals processes.
- Streamlined appeal workflows, resulting in improved processing times and accuracy.
- Created, composed and maintained appeal response templates.
- Maintained strict confidentiality of patient information in accordance with HIPAA regulations.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Ensured timely completion of all assigned audits while maintaining a high level of detail and accuracy.
- Trained new Quality Auditors on best practices, increasing their proficiency in performing audits effectively.
- Trained and reviewed work of junior personnel on departmental responsibilities.
- Completed timely quality reports highlighting deficiencies and recommending corrective actions.
- Scheduled and executed 30 monthly audits.
- Resolved customer inquiries efficiently, enhancing overall satisfaction with the appeal process
- Developed training materials for ongoing employee development initiatives.
- Entered and maintained accurate data in company databases to ensure information integrity.
- Assisted in training new staff on data entry protocols and software applications.
- Followed established procedures to enter and process data correctly.
- Completed non medical decision outpatient services, Part D and Durable Medical Equipment
- Improved customer satisfaction rates by providing timely and empathetic responses to appeals inquiries.
- Displayed excellent time management skills while managing multiple high-priority cases concurrently without compromising quality or attention to detail.
- Resolved escalated cases promptly and effectively.
- Responded to attorney inquiries and litigation notice
Education
High School Diploma -
Miami Northwestern Senior High
Miami, FL06-1991
Skills
- Organizational growth
- HIPAA compliance
- Effective communication
- Professionalism and ethics
- Data entry proficiency
- Strong analytical skills
- Appeals process proficiency
- Time management
- Verbal and written communication
- Decision-making
- Microsoft office
- Document review
- Coverage determination
- Dispute resolution
Timeline
RA1 , Appeal Specialist, RA2, RA3, Quality Auditor
C2C Solutions
11.2011 - 11.2025
High School Diploma -
Miami Northwestern Senior High