Donna Jones
Baton Rouge,LA
Summary
To leverage my expertise in healthcare billing and coding, along with my proficiency in data analysis and auditing, to effectively investigate and prevent fraudulent or inaccurate claims, ultimately contributing to the financial health and integrity of the organization.
Skillful in researching and resolving billing discrepancies and claims. Disciplined and energetic professional well-versed in medical claim appeal processing, clinical relations, and medical billing.
Overview
17
17
years of professional experience
Work History
Senior Provider Relations Representative
Blue Cross and Blue Shield of Louisiana
03.2023 - Current
- Over see the maintenance and accuracy of provider databases and directories.
- Ensure compliance with industry regulation and guidelines related to provider information.
- Act as a subject matter expert on provider information systems and software.
- Acted as a liaison between providers and internal departments, ensuring effective collaboration towards common goals.
- Analyze and report on provider on provider data trends and discrepancies.
- Provided exceptional customer service to providers during the credentialing process, ensuring a smooth experience for all parties involved.
- Participate in cross-functional teams and projects related to provider information management.
- Review and process credentialing applications, EFTC enrollments, and changes, provider joining new group requests, facilitate the start of new groups, and update provider demographics.
Charge Poster
The Retina Center
05.2021 - 03.2023
- Worked closely with aging team to send resubmitted claims.
- Efficiently processed high volumes of medical claims while ensuring accurate data entry and maintaining strict confidentiality.
- Communicated with supervisors on insurance issues, trends and reimbursement setbacks affecting cash flow by monitoring insurance accounts.
- Enhanced revenue for the organization through timely and accurate submission of medical claim forms.
- Review and verify coding on charge documents.
- Ensure charges are correctly entered into the billing system.
Front Office Manager
Retina & Vitreous Of Louisiana
02.2019 - 03.2022
- Monitored financial transactions at the front desk, ensuring accurate billing procedures and minimizing discrepancies.
- Created weekly schedules for front office staff members to ensure appropriate coverage during peak hours or high demand periods.
- Reconciled end-of-day reports to determine accurate billing and payment processing.
- Resolved guest complaints professionally, maintaining positive relationships with customers for future business opportunities.
- Reviewed and researched charge sheets for each visit to ensure accurate matching fo charges to the visit.
Front Office Coordinator
CVT Vascular Lab
09.2014 - 03.2019
- Handled financial transactions responsibly, collecting copayments and processing payments with attention to detail.
- Improved patient relations by proactively addressing concerns or complaints with professionalism and empathy.
- Supported administrative tasks such as filing, data entry, and document management to maintain an organized office environment.
- Managed high call volumes effectively, addressing patient inquiries and resolving issues promptly.
Patient Access Supervisor
Memorial Hermann Sports Medicine And Rehabilitation
01.2008 - 08.2014
- Implemented quality assurance measures to ensure that patient access processes adhered to hospital policies and industry best practices for optimal service delivery.
- Reduced employee turnover rate by fostering a positive work environment and providing ongoing support for professional development opportunities.
- Implemented performance metrics to track department productivity, identifying areas for improvement and driving overall efficiency gains.
Education
Medical Coding -
Career Steps
Lehi, UT09.2024
Certificate Office Management -
Louisiana Vo Tech
Alexandria, LA05.2006
High School Diploma -
Tara High School
Baton Rouge, LA05.2001
Skills
- Knowledge of Healthcare Procedures and Services
- Teamwork and Collaboration
- Problem-Solving Skills
- Multitasking
- Analytical Skills
- HIPAA compliance awareness
- Insurance Verification Proficiency
- Claims Processing Efficiency
- Strong Communication Skills
- Charge Entry and Posting
- Reconciliation of Charges
- Proficient in ICD-10 Coding
Timeline
Senior Provider Relations Representative
Blue Cross and Blue Shield of Louisiana
03.2023 - Current
Charge Poster
The Retina Center
05.2021 - 03.2023
Front Office Manager
Retina & Vitreous Of Louisiana
02.2019 - 03.2022
Front Office Coordinator
CVT Vascular Lab
09.2014 - 03.2019
Patient Access Supervisor
Memorial Hermann Sports Medicine And Rehabilitation
01.2008 - 08.2014
Medical Coding -
Career Steps
Certificate Office Management -
Louisiana Vo Tech
High School Diploma -
Tara High School