Jasmine Jackson
6853 Trailride S Milton,FL
Summary
Experienced Claims Processor with expertise in adjudicating Medical Insurance claims . This includes thorough researching and analyzing financial/analytical data, benefit plans, and Coordination of Benefits. Working knowledge of ICD 10, HCPCS , CPT Codes and Medical Terminology. Excels in environments with Productivity and Quality Metrics/Goal . Served as primary point of contact between management, personnel, customers, and vendors. Proven record for superior customer service, client confidentiality, and integrity.
Overview
17
17
years of professional experience
Work History
Appeals Specialist
Global Medical Response
08.2024 - Current
- Enhanced overall department efficiency by developing and implementing standardized procedures for handling appeals cases.
- Reduced claim denial rates with thorough pre-appeal reviews, identifying potential issues before submission.
- Maintained high levels of accuracy in all written correspondence, ensuring clear communication with relevant stakeholders during the appeals process.
- Developed strong relationships with healthcare providers, insurance companies, and regulatory agencies to facilitate successful outcomes in the appeals process.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
Claims Processor
NTT Data Services
10.2020 - 08.2024
- Adjudicate BCBS Medicare claims with complete end to end , accurate and timely claims review; performs final decision making , overpayments/adjustments, and interpretation of claims relative to Benefit Plan
- Extensive research for schedule of benefits , identifying HCPCS/CPT/ICD 10 procedure codes, diagnosis codes and provider information necessary for claims adjudication
- Ensured compliance with all applicable regulations by maintaining strict adherence to HIPAA guidelines and company protocols when handling sensitive patient information.
- Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
Claims Examiner
Change Healthcare
10.2017 - 01.2020
- Adjudicated BCBS claims with accountability, accuracy, critical thinking and timely filing
- Consistently adhere to SOP’s and SLA’s for quality control, which contributes to taking on more contracts with BCBS
- Meet monthly quotas for productivity and quality control at 90-95%
- Manually produce medical records requests for each claim when needed, while performing follow up actions
- Handled verbal and written inquiries / requests from Insurance Provider and customers
- Record keeping and produced reports with excel spreadsheets on a monthly basis
- Used correct interpretation of ICD 10, CPT, and Diagnoses codes for correct Medical Terminology of claim
Administrative Specialist (Senior)
90 Work/Medical Foster Care
06.2015 - 01.2017
- Served as a senior administrative specialist responsible for implementing and administering a variety of administrative tasks, direct business relations, document management, quality control, application protocol, and maintained equipment tracking records
- Processed monthly expense reports reflecting supporting documentation
- Maintained monthly budget of $5,000.00 for inventory
- Prepared financial spreadsheets, correspondence, and memos
- Provided calendar management, schedule of meetings, document preparation, and travel arrangements
- Created and maintained electronic file system and paper files
Employment Security Representative
Department of Economic Opportunity
10.2013 - 01.2015
- Performed a wide variety of administrative and analytical duties connected with the review, research and analytics, and general data entry functions
- Call center representative and provided support for unemployment claims and compensation
- Researched and analyzed claim processes
- Maintained agency call center processing over 50 telephone inquiries daily
- Maintained accuracy and processed disbursements
- Provided customer service and support for customers
- Monitored and tracked call logs
Claims Processer
Xerox State Healthcare
08.2009 - 04.2013
- Researched and provided claims support for clientele, third party insurances, and medical doctors
- Generated reports, reconciled and ensured accuracy of medical claims and disbursements
- Inspected allocations of deductibles, co-pays, co-insurance, and reimbursements
- Processed and researched over 1,000 medical billing and claims bi-weekly
- Resolved issues involving customer complaints and claim adjudications
- Investigated overpayments and fund requirements
- Conducted regular audits and monthly reconciliations for quality control
- Analyzed claims for accuracy, proper account charges, coding, and compliance within Florida statutes and agency guidelines logging and reporting any deficiencies and material weaknesses to senior management
Forms Maintenance Specialist
Fringe Benefits Management Co.
08.2007 - 08.2009
- Organized the daily flow of forms for processing and archival
- Maintained logs, filing enrollment, and document management through image management system and hard-copy file cabinets
- Wrote correspondence and memos and prepared benefit enrollment notice
- Reviewed and verified data and printing of enrollment forms and documents
- Performed audit review for indexing
- Copied and sorted enrollment forms to clients and providers
- Batched and logged enrollment forms
Education
Medical Coding Certification -
Allied Health Institute
05.2011
Skills
- Claims Adjudication
- Accuracy and Precision
- Transactions reconciliation
- Medical terminology knowledge
- Critical Evaluation / Quality Review
- Records/Database Management
- Continuous learning mindset
- HIPAA compliance
- Effective communication
Contact
6853 Trailride S Milton, FL 32570
Timeline
Appeals Specialist
Global Medical Response
08.2024 - Current
Claims Processor
NTT Data Services
10.2020 - 08.2024
Claims Examiner
Change Healthcare
10.2017 - 01.2020
Administrative Specialist (Senior)
90 Work/Medical Foster Care
06.2015 - 01.2017
Employment Security Representative
Department of Economic Opportunity
10.2013 - 01.2015
Claims Processer
Xerox State Healthcare
08.2009 - 04.2013
Forms Maintenance Specialist
Fringe Benefits Management Co.
08.2007 - 08.2009
Medical Coding Certification -
Allied Health Institute
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