Jauquashia Jones
Allentown,PA
Summary
Experienced in the field of medical claims management. Possess thorough understanding and knowledge of health insurance policies, coding, billing procedures and compliance regulations. Strengths include efficiency in reviewing, analyzing and managing medical claims with accuracy. Notable impact made by reducing errors, streamlining processes and improving overall operational efficiency at previous employment.
Overview
13
13
years of professional experience
Work History
Medical Claims Specialist
Guardian Life Insurance
Bethlehem, Pennsylvania
2021.08 - Current
- Verified patient eligibility for medical claims and determined benefit coverage.
- Submitted and tracked medical claims to insurance companies via electronic or paper methods.
- Resolved issues related to denied or underpaid claims in a timely manner.
- Maintained accurate records of all claim activities for audit purposes.
- Processed appeals on rejected or partially paid claims, including filing additional paperwork as needed.
- Collaborated with other departments regarding changes to existing processes and procedures.
- Adhered to HIPAA regulations while managing confidential patient information.
- Audited provider bills for accuracy before submission to insurance companies.
- Responded promptly to customer inquiries regarding claim status updates.
- Conducted research into complex medical coding issues to ensure proper reimbursement.
- Reviewed denials, rejections, and underpayments from insurance carriers.
- Generated reports detailing claim activity metrics such as volume, turnaround time.
- Identified incorrect charges on invoices by comparing them against contracts and fee schedules.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Reviewed claims for accuracy before submitting for billing.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
Medical Assistant
Hamburg State Hospital
Hamburg, Pennsylvania
2017.11 - 2022.12
- Provide daily support to participants that are low functioning and have intellectual disabilities, autistic, and give meds crushed up and via feeding tubes
- Take to all doctors appts and take out into the community for outings
- Schedule appts and order any meds that may need refills
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Maintained accurate medical records through filing, charting, transcription and data entry into electronic health record system.
- Inspected equipment to ensure proper working order prior to use on patients.
Medical Assistant
Everyday Home Care
Allentown, PA
2016.08 - 2017.11
- Assist with daily living such as bathing, grooming, cooking and cleaning
- Assist with getting the participant to doctors appts and ordering their prescriptions
DSP
Life Path
2016.08 - 2016.11
- Assist with the daily living, bathing, grooming, meal preparation
- Take to appts and out into the community
Auto Claims Rep
Liberty Mutual
2013.03 - 2016.08
- Inbound and outbound phone calls to recover funds and investigate accidents
- Negotiate with third party such as at fault driver or insurance company
- Assist in arbitration writing and reviewing
- Making settlement decisions such as liability decision and percentage
- Collections when person or company is uninsured
- Check several systems to see if accident was staged, planned, etc
- Communicate via phone, email, or IM
Customer Service Representative
Wells Fargo
2012.03 - 2013.03
- Take inbound calls and provide customers with account balance
- Assist with providing the interest rates
- Also provide information on account eligibility
- Sale additional accounts such as IRAʼs, stocks and bonds, etc
Education
Associate of Arts - Liberal Arts And Sciences
Reading Area Community College
Reading, PA2024-05
Diploma - College Prep
Louis E Dieruff High School
06.2009
Skills
- Customer service skills
- Attention to detail
- Detail oriented
- Outgoing
- Team leader
- Quick learner
- Positive attitude
- Medical Billing
- Medicaid knowledge
- Claims Processing
- Insurance Verification
- Interpersonal abilities
- HIPAA knowledge
- Payment posting
- Medical Coding
- Thorough claims reviews
- Critical Decision-Making
- Telephone Etiquette
- Medical terms and procedure knowledge
- Medical Terminology
- Claim validity determination
Languages
English, Full professional proficiency
Timeline
Medical Claims Specialist
Guardian Life Insurance
2021.08 - Current
Medical Assistant
Hamburg State Hospital
2017.11 - 2022.12
Medical Assistant
Everyday Home Care
2016.08 - 2017.11
DSP
Life Path
2016.08 - 2016.11
Auto Claims Rep
Liberty Mutual
2013.03 - 2016.08
Customer Service Representative
Wells Fargo
2012.03 - 2013.03
Associate of Arts - Liberal Arts And Sciences
Reading Area Community College
Diploma - College Prep
Louis E Dieruff High School