Ivory Jones
Oak Park,MI
Summary
Dynamic Claims Team Lead with extensive experience at Molina Healthcare, excelling in claims processing and compliance. Proven ability to enhance team performance through effective training and communication. Skilled in ICD-10 coding and patient relations, ensuring high-quality service delivery while maintaining adherence to HIPAA regulations. Committed to achieving operational excellence.
Overview
20
20
years of professional experience
Work History
Claims Team Lead
Molina Healthcare/ Firstsource Healthcare
09.2019 - Current
- Provide expert and general claims support by reviewing,researching, investigating,processing,and adjusting claims, while actively assisting claim examiners to ensure accuracy, efficiency,and adherence to policy guidelines.
- Oversee claims operations by managing workflow, assigning tasks and driving team performance to meet service and compliance goals.
- Review complex claims for accuracy, compliance and completeness before final payment approval.
- Train new hires and existing claim examiners on claims processing procedures and benefits guidelines to ensure consistent application of policies and high quality service delivery.
- Lead and support the team during supervisor absences to ensure seamless operations and consistent service delivery.
- Maintain professional client relationship
Claims Examiner
Molina Healthcare
11.2014 - 09.2019
- Responsible for reviewing claims after they are submitted to ensure proper guidelines and processes have been followed
- Assists adjusters with complicated claims
- Establish claim information while verifying coding and other documentation within claim
- Analyze claims to determine eligibility per insurance allowance while verifying compliance with state insurance regulation identify action plans; Determine if claim can be paid or if further research is needed and make timely case decisions based on corporation expectations
- Maintain professional client relationship
Consultative Sales Associate
Sears
07.2005 - 11.2014
- Excellent Customer Service
- Completing sales
- Stocking merchandise
- Maintaining organization on sales floor
- Assisting team fellow team members
- Balancing cashier drawer for opening and closing shift
Education
Medical Administration And Billing Program - Billing And Coding
Dorsey College
Farmington Hills, MI02-2014
Skills
- Excellent Communication Skills
- Pleasant problem solving
- Human anatomy and physiology
- Medical office administration
- Business communications
- Microsoft Office Software 2010&2011
- Claim forms -UB/HCFA
- HIPPA compliance procedures
- Patient and family communication skills
- EMR/EHR
- ICD-9 & 10, CPT, HCPCS
- CMS/Commerical EOB
Timeline
Claims Team Lead
Molina Healthcare/ Firstsource Healthcare
09.2019 - Current
Claims Examiner
Molina Healthcare
11.2014 - 09.2019
Consultative Sales Associate
Sears
07.2005 - 11.2014
Medical Administration And Billing Program - Billing And Coding
Dorsey College
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