Jaimie Byers
Baldwin
Summary
Accomplished Healthcare Informatics professional (MS) and Provider Account Management with over 7 years of experience optimizing revenue cycle operations within large-scale health systems. Expert in acting as a strategic liaison between physicians and administration to ensure financial stability and billing accuracy. Proven track record in resolving complex insurance denials, auditing fee structures. Highly proficient in QNXT and CaseTrakker, with a specialized focus on staff mentorship, claims resolution, and clinical documentation improvement.
Overview
7
7
years of professional experience
Work History
Network Account Coordinator
Elevance Health
01.2025 - 03.2026
- Managed an extensive provider portfolio, acted as the bridge between the health plan and the providers.
- Trained new hires how to use internal data bases, billing system QNXT, and case management system Casetrakker.
- Determined the reason for complex claim denials by to analyzing remittance advice and claims data.
- Acted as the resource person for the resolution of complex billing situations.
- Coordinated the request for documentations.
- Educated physician on plan-specific billing requirements, ICD-10/CPT coding nuances, and authorization procedures to reduce administrative errors and streamline the revenue cycle.
- Responsible for insuring the providers meet HEDIS star measures.
- Spearheaded the retrieval of medical records for HEDIS and meet strict NCQA deadlines.
- Worked well in a team setting, providing support and guidance ensuring team-wide proficiency
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Provided exceptional communication, handling sensitive patient situations with professionalism and empathy.
- Identified trends in unpaid accounts.
- Prepared reports detailing billing actions, flags, and other key information.
- Coordinated project timelines and deliverables across multiple teams to ensure alignment with strategic objectives.
- Developed and maintained comprehensive client correspondence to enhance communication and service delivery.
Network Account Managment Coordinator
Centers Plan for Healthy Living
10.2018 - 12.2024
- Managed an extensive provider portfolio, acted as the bridge between the health plan and the providers.
- Trained new hires how to use internal data bases, billing system QNXT, and case management system Casetrakker.
- Determined the reason for complex claim denials by to analyzing remittance advice and claims data.
- Acted as the resource person for the resolution of complex billing situations.
- Coordinated the request for documentations.
- Educated physician on plan-specific billing requirements, ICD-10/CPT coding nuances, and authorization procedures to reduce administrative errors and streamline the revenue cycle.
- Responsible for insuring the providers meet HEDIS star measures.
- Spearheaded the retrieval of medical records for HEDIS and meet strict NCQA deadlines.
- Worked well in a team setting, providing support and guidance ensuring team-wide proficiency
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Provided exceptional communication, handling sensitive patient situations with professionalism and empathy.
- Identified trends in unpaid accounts.
- Prepared reports detailing billing actions, flags, and other key information.
- Coordinated interdisciplinary team meetings to enhance communication and streamline project workflows.
Education
Masters of Science - Health Care Informatics
Adelphi University
Garden City, NY01-2018
Skills
- Smartsheets
- Account management
- Detail Oriented
- Troubleshooting and problem resolution
- Knowledge of CMS-1500 forms
- Microsoft Office Excel
- Microsoft Office PowerPoint
- Microsoft Office Word
- Provider Relations
- Verbal and written communication
- Organizational skills
- ICD-10 & CPT Coding
- PaySpan
- Resolution of complex billing
- QNXT System Knowledge
- CaseTrakker Knowledge
- Data Analysis
- Staff Mentorship
- Multitasking
- Independent work
- Interpersonal Skills
- Time management
- Microsoft Office Suite
- Soft skills
- RelayHealth
- Hands on Learner
- HIPAA compliance
- Team collaboration
- Medical billing
- Data entry proficiency
- Billing & Claims Advocacy
- HIPAA
Timeline
Network Account Coordinator
Elevance Health
01.2025 - 03.2026
Network Account Managment Coordinator
Centers Plan for Healthy Living
10.2018 - 12.2024
Masters of Science - Health Care Informatics
Adelphi University