Jeanette Jones
Fayetteville,NC
Summary
Driven professional with a diverse skill set and a success across various roles. Adept at leveraging strong interpersonal, organizational, and communication skills to drive collaboration and achieve objectives. Committed to continuous improvement and delivering high-quality outcomes in fast-paced environments. Eager to contribute to team success and support organizational goals through adaptability and a solutions-oriented mindset.
Overview
19
19
years of professional experience
Work History
Business Analyst III
The Elevance Health
11.2022 - Current
- Analyzed complex user needs and identified optimal software solutions
- Developed project plans and coordinated cross-functional resources
- Collaborated with programming teams for system design and testing integration
- Provide support to software users by addressing questions and issues
- Facilitated stakeholder workshops and meetings to ensure project alignment
- Proficient in Jira, Confluence, and experienced in relational databases and query tools
- Developed and executed detailed test cases, identified data needs, and manage UAT updates
- Strong analytical, organizational, presentation, and problem-solving skills
- Knowledgeable in using CCERT, Facets and ACR systems
Business Analyst II
The Elevance Health
10.2020 - 11.2022
- Proficient in Payment Integrity Data Mining Operations and business processes
- Knowledgeable in claims processing, facility contract language, reimbursement policy, and provider manuals, including systems like ACR, WGS, WGS/Kernal, CI&W, and CS90
- Skilled in MS Office applications: Excel, Word, Teams, OneNote, PowerPoint, SharePoint
- Conducted overpayment assessments by reviewing claims
- Collaborated with query developers, business owners, and consultants
- Demonstrated excellent organizational skills; effective independently and collaboratively
- Identified and implemented process improvements for increased savings
- Update Business Requirement Documents (P&P)
- Strong problem-solving skills
- Conducted audits through the Tracker to identify potential recoveries
- Provided education and support to associates regarding potential recoveries to foster better understanding and enhance overall processes
Financial Ops Recovery Specialist III
The Elevance Health
11.2005 - 10.2020
- Audit paid claims for overpayments using queries and specialized reporting
- Collaborate with cross-departmental staff and management for customer satisfaction
- Work with recovery vendors to validate overpayments and modify queries
- Partner with contract managers to address contractual issues
- Conduct complex case research and resolution
- Perform collection activities for overpayment recovery and manage cash applications
- Review associates' work for quality and monitor department policy accuracy
- Assist in special projects to prevent overpayments and identify process improvements
- Complete assigned projects with minimal supervision
- Research and verify voluntary refunds
- Ensure accurate account balancing
Education
Associate of Arts - Medical Assistance
Bryant Stratton College
Albany, NY06.2009
Skills
- Word
- Excel
- PowerPoint
- One Note
- SQL
- Toad Oracle
Timeline
Business Analyst III
The Elevance Health
11.2022 - Current
Business Analyst II
The Elevance Health
10.2020 - 11.2022
Financial Ops Recovery Specialist III
The Elevance Health
11.2005 - 10.2020
Associate of Arts - Medical Assistance
Bryant Stratton College
Similar Profiles
Nina CooperNina Cooper
Member Service Representative at IU Health Plans / Elevance HealthMember Service Representative at IU Health Plans / Elevance Health
Katherine Lugo-DelgadoKatherine Lugo-Delgado
Provider Network Manager Sr. at Carelon Behavior Health (Subsidiary of Elevance Health)Provider Network Manager Sr. at Carelon Behavior Health (Subsidiary of Elevance Health)
Sai Kumar RallabandiSai Kumar Rallabandi
Associate Software Engineer(Big Data) at Legato Health Technologies (Elevance Health)Associate Software Engineer(Big Data) at Legato Health Technologies (Elevance Health)
Carlee RobinsonCarlee Robinson
Veterans Service Representative at Department of Veterans AffairsVeterans Service Representative at Department of Veterans Affairs
Monzella PageMonzella Page
Hairstylist at Blessed CreationsHairstylist at Blessed Creations