Jennifer Byerly
Gulfport,MS
Summary
Professional and prepared for role, bringing experience in medical claims review and analysis. Skilled in claims adjudication, compliance verification, and problem-solving with strong focus on team collaboration and achieving outcomes. Reliable and adaptable in dynamic environments, consistently demonstrating thoroughness and integrity. Proficient in medical coding, regulatory requirements, and effective communication.
Overview
26
26
years of professional experience
Work History
Medical Claims Examiner
Health Plans, Inc
Westborough, MA
08.2024 - Current
- Analyzed medical claims for accuracy and compliance with policies and regulations.
- Reviewed documentation to ensure adherence to insurance guidelines and eligibility requirements.
- Collaborated with healthcare providers to resolve discrepancies in claim submissions.
- Conducted audits of claims processing for quality assurance and efficiency improvements.
- Maintained compliance with industry regulations and company policies while evaluating medical claims for accuracy and legitimacy.
Precertification Specialist II
Memorial Hospital at Gulfport
Biloxi, Mississippi
02.2020 - 07.2024
- Maintain Full-Time status; 40 hour work week; overtime as needed
- Responsible for obtaining prior authorizations for the ENT, Float Nurse Practitioners, Orthopedic, Orthopedic Trauma, Urology and Vascular surgeons on a daily basis as well as other surgical and non-surgical physician office as assigned
- Collaborated with healthcare providers to gather necessary information for precertification requests.
- Streamlined communication between departments to enhance workflow efficiency and reduce processing time.
- Reviewed and analyzed clinical documentation to facilitate timely approvals for medical services.
- Coordinated precertification processes for patient procedures to ensure compliance with insurance requirements.
- Mentored junior staff on effective precertification practices, improving overall team performance.
- Prior authorizations include medication to be given to patient in office, in-office surgical procedures, out-patient and in-patient surgical procedures (office visit as required for Veterans from the VA)
- Responsible for ensuring all patient insurance is correctly added and maintained in the patients chart to accurate billing
- Add all ICD10 and CPT codes required to the Memorial Experian portal for patient billing and accurate reporting systems for the authorization department
- Responsible for obtaining access to all insurance portals to obtain prior authorization for patients surgical procedures, imaging and medication injections
- Assist patients with updates to the patients chart when address changes are made, insurance changes and emergency contacts
- Boosted efficiency within the team by regularly updating coworkers on changes in insurance policies or procedural requirements affecting precertifications.
Precertification Specialist Business office Rep
Memorial Hospital at Gulfport
Gulfport, Mississippi
09.2017 - 02.2020
- Maintain Full-Time status; 40 hour work week; overtime as needed
- Checked patients in and out for office visits
- Answered phones and sent messages to the nurses and physicians daily
- Worked messages in our office pool and returned patient calls daily
- Verified patient insurance/insurances and pre-registered patient appointments daily
- VA liaison/point of contact for community care patients
- Assisted in training new hire business office representatives
Office Manager
Classy Chassis Car Wash
Biloxi, Mississippi
06.2016 - 09.2016
- Managed Car Wash business office and assisted accountant with car wash billing and collections
- Managed all car wash cashiers with scheduling and PTO
- Trained all new hires across 3 separate locations
- Discuss job performance problems with employees to identify causes and issues and to work on resolving problems.
- Resolve customer complaints or answer customers' questions regarding policies and procedures. Recruit, interview, and select employees.
Technical Product Support-Tech 1
WMS Industries
Gulfport, Mississippi
04.2000 - 07.2015
- Maintain Full-Time status; 40 hour work week; overtime as needed and required
- Responsible for taking incoming calls from Casinos all over the United States and assisting the Tech Manager with all parts and services required for the slot machines on the casino floor
- Responsible for maintaining an accurate inventory of slot machines parts and products for casino gaming
- Trained all new parts department new hires
- Assisted in writing the technical training material for all new Parts Department new hires
- Maintained all of the Field Service Technicians vans with parts and accurate inventory
- Followed all Gaming Regulations for each state when shipping parts and products to each state
- Extensive electronic gaming device knowledge to triage, trouble shoot and rapidly resolve poor functionality or device downtime
Education
Bachelor of Science - Health Service Management
Independence University
Salt Lake City, Utah04-2020
Skills
- Customer service focus
- Claims processing proficiency
- HIPAA compliance
- Teamwork orientation
- Professionalism and ethics
- Medical terminology
- Documentation review
- Data entry efficiency
- Healthcare regulations
- Medical coding expertise
- Disability claims process
- Insurance policies
- Medical record review
- Insurance claims processing
- Quality assurance checks
- Thorough claims reviews
- Insurance verification
Timeline
Medical Claims Examiner
Health Plans, Inc
08.2024 - Current
Precertification Specialist II
Memorial Hospital at Gulfport
02.2020 - 07.2024
Precertification Specialist Business office Rep
Memorial Hospital at Gulfport
09.2017 - 02.2020
Office Manager
Classy Chassis Car Wash
06.2016 - 09.2016
Technical Product Support-Tech 1
WMS Industries
04.2000 - 07.2015
Bachelor of Science - Health Service Management
Independence University