Jenelle Moore
Memphis,United States
Summary
Approachable Medical Claims Processor, proudly offering nine years of experience in handling multiple administrative responsibilities in fast-paced office environments. Highly motivated employee with a desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively, unsupervised, and quickly mastering new skills. Patient-focused professional equipped with administrative and customer service expertise. Helps keep healthcare services proceeding smoothly by coordinating communications, referrals, and policy enforcement. Talented in finding balanced solutions and resolving conflicts.
Overview
5
5
years of professional experience
Work History
Hospital Admissions Coordinator
Lakeside Behavioral Healthcare
Bartlett, TN
08.2024 - Current
- Compiled and coded patient information or data in appropriate computer system.
- Verified patient insurance information and obtained authorizations for services from insurance companies.
- Communicated with patients with compassion while keeping medical information private.
- Implemented policies to ensure compliance with applicable laws and regulations.
- Explained policies, procedures and services to patients.
- Routed laboratory or diagnostic results to appropriate staff.
- Monitored patient care quality and safety standards in accordance with Joint Commission guidelines.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
Patient Service Representative
OPUS Health
Remote, TN
01.2024 - 08.2024
- Handled daily credit card transactions efficiently.
- Guided patients to suitable specialists and services.
- Ensured compliance with HIPAA privacy and security standards.
- Effectively addressed inquiries, leading to quick issue resolution.
- Analyzed and verified financial information to ensure the accuracy of application data.
- Demonstrated strong multitasking abilities while handling high call volumes, and maintaining detailed records.
ER Registration Representative
Methodist University Hospital
Memphis, TN
06.2022 - 01.2024
- Oversaw front office operations to enhance workflow efficiency
- Completed relevant insurance and other claim forms.
- Connected callers with appropriate medical and administrative personnel
- Arranged hospital admissions for patients as required.
- Managed patient admissions, transfers, and discharges,
- Processed patient paperwork in collaboration with nursing staff and colleagues
- Interviewed patients to complete case histories and intake forms.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Performed verification of Medicare coverage.
- Identified important patient and demographic information.
Prior Authorization/Collection Account Representative
Cigna
Remote, TN
01.2021 - 01.2023
- Utilized CMM for entering claim details
- Notified ordering providers of denied authorizations.
- Coordinated resolutions for issues and appealed denied authorizations.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Verified patient's insurance eligibility prior to appointment date for payment purposes.
- Conducted outbound calls to confirm patient eligibility
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Conveyed precise details to patients, insurers, healthcare staff, and office personnel using effective communication skills.
- Maintained unwavering professionalism in communications with medical professionals and insurers
- Coordinated peer-to-peer reviews addressing healthcare needs with insurers
- Revised guidelines and policies for insurance plan acceptance
Health Insurance Claims Adjudicator
Fresenius Medical Center
Nashville , TN
08.2020 - 12.2020
- Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Processed extensive quantities of medical claims efficiently each shift
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Determined payment and denials for medical claims based on set standards
- Sent clinical request and missing information letters to obtain incomplete information.
Education
Associate of Applied Science - Occupational Therapy Assistant
Concorde Career College
Memphis, TNSkills
- ICD code fluency
- Critical thinking
- Account management
- Computer skills
- Customer service
- Quality assurance and control
- Problem-solving skills
- Medical terminology
- Financial Counseling
- HIPAA compliance
- Admissions
- Insurance verification
- Medical Coding
- Data entry
- Detail-oriented
- Documentation skills
- Insurance forms processing
- Benefits explanation
- Patient intake
- Conflict resolution
- Dispense medicines
- Behavioral management
- Cognitive behavioral therapy principles
- Decision-making
- High Call Volume management
Timeline
Hospital Admissions Coordinator
Lakeside Behavioral Healthcare
08.2024 - Current
Patient Service Representative
OPUS Health
01.2024 - 08.2024
ER Registration Representative
Methodist University Hospital
06.2022 - 01.2024
Prior Authorization/Collection Account Representative
Cigna
01.2021 - 01.2023
Health Insurance Claims Adjudicator
Fresenius Medical Center
08.2020 - 12.2020
Associate of Applied Science - Occupational Therapy Assistant
Concorde Career College
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