Jeanice Fanslow
Medical Claims Lead/Adjudicator
Cosmopolis,WA
Summary
* Claims Lead with expertise in both facility and professional Medicare Advantage claims adjudication. Eight years of medical claims adjudication experience plus over ten years of medical claims billing experience. Proficient in medical claims processing from claim ingestion to check run. Motivates and leads by example to get things done.
* Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
* Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Overview
18
18
years of professional experience
Work History
Claims Lead
Physicians of SW Washington
06.2016 - Current
- Supervises a team of Medicare Advantage adjudicators and customer service staff providing training and guidance to ensure timely and accurate claims adjudication
- Manages adjudication of all facility and professional claims for multiple lines of business in accordance with Medicare & Medicare Advantage and department guidelines/policies in EZCAP
- Tracks claim financial transactions including claim payments, claim refunds and recoups, with a high degree of accuracy compliance deadlines, often utilizing Excel spreadsheets
- Prepares, processes and distributes claim checks to include creating and maintaining check processing files
- Prepares and completes check run in EZCAP, including preparing and auditing of member denial letters
- Composes and runs ad hoc SYMKEY queries as needed to support Claims Team needs
- Uses ENCODER regularly as a resource in daily work and teaches others about this tool
- Implements new P&P and company initiatives as assigned and ensures all areas are maintained in accordance with company, state, federal and plan regulatory mandates
- Continually reviews assigned areas of responsibility and give suggestions to supervisor on how to enhance service/products
- Conducts trainings for Claims Department personnel, providing crossover training on a multitude of subjects
- Builds and leverages cross-functional collaborative relationships to facilitate a team-work oriented atmosphere and achieve company goals
- Works with supervisor to evaluate Claim Team member's strengths and weaknesses and areas of improvement needed
Medical Claims Biller
Quality Billing and Bookkeeping
04.2007 - 07.2018
- Prepared and accurately submit HCFA medical claims to insurance carriers - paper and EDI
- Posted all insurance and patient payments and process secondary/tertiary insurance claims
- Reviewed all claims for contractual write offs and collection of any remaining balances
- Followed up on denials, initiate appeals, monitored unpaid accounts, reviewed accounts receivable write offs
- Prepared monthly patient statements and financial reports of all clinic practice activity
- Scheduled patient visits and answered all patient billing questions
Medical Claims Biller
Nightingale Medical Billing
07.2013 - 06.2016
- Submitted accurate HCFA claims, reducing errors and improving reimbursement rates
- Processed payments and claims, enhancing cash flow and reducing outstanding balances
- Reviewed claims for write-offs, optimizing revenue collection and minimizing losses
- Handled patient communications, ensuring clarity in billing and timely payment collection
- Optimized accounts receivable by diligently reviewing contractual write-offs, monitoring unpaid accounts, and implementing effective collection strategies
- Meticulously managed patient accounts, ensuring precise posting of payments and thorough processing of secondary/tertiary insurance claims
- Fostered positive patient relationships through clear communication, addressing account inquiries and facilitating smooth payment processes
- Managed denials and appeals effectively, improving claim acceptance rates and minimizing unpaid accounts, leading to improved financial outcomes
Full Charge Bookkeeper
Fort Lewis Thrift Shop
12.2009 - 05.2011
- Managed comprehensive financial operations, including payroll processing, tax filings, and QuickBooks general ledger entries for retail sales figures
- Recorded sales and maintained ledgers, enhancing financial transparency
- Prepared and presented concise financial statements to Board of Directors, facilitating informed decision-making and strategic planning
- Maintained meticulous accounts receivable, payable, and consignment ledgers, ensuring accurate financial records for CPA review and audits
- Handled accounts receivables and payables, improving cash flow management
Education
High School Diploma -
Porterville Union High School
Porterville, CaliforniaSkills
- Auditing
- Medicare
- CMS
- HIPAA
- EDI
- Process Development
- Billing
- Financial Transactions
- Financial Reporting
- Insurance Claims
- Training
- Adjudication
- Leadership
- Microsoft Office
- Time Management
- Transaction Processing
- Check Processing
- Claims Processing
- Health Insurance
- Accounts Receivable
- Corporate Policies
- Compliance
- Team leadership experience
- Medical billing
- HIPAA compliance
- ICD-10 coding
- Analytical problem solving
- Claims review
- Medical terminology
- Policy interpretation
- Insurance regulations
- Accuracy and precision
- Regulatory compliance
- Process improvement strategies
- Project management experience
- Transactions reconciliation
- Payments posting
Personal Information
Work Permit: Authorized to work in the United States
Timeline
Claims Lead
Physicians of SW Washington
06.2016 - Current
Medical Claims Biller
Nightingale Medical Billing
07.2013 - 06.2016
Full Charge Bookkeeper
Fort Lewis Thrift Shop
12.2009 - 05.2011
Medical Claims Biller
Quality Billing and Bookkeeping
04.2007 - 07.2018
High School Diploma -
Porterville Union High School
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