Jennifer Clark
Gate City ,USA
Summary
A seasoned leader in healthcare management, adept in strategic planning and process improvement, with a proven track record at Ensemble Health Partners. Skilled in Microsoft Office and team building, I've significantly enhanced operational efficiency and achieved key performance metrics, including a notable $1.8 million savings in denied claims resolution.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Director, Pre-Access
Ensemble Health Partners
Remote
12.2021 - Current
- Developed and implemented comprehensive strategies to improve operational processes and organizational efficiency.
- Identified opportunities for improvement in operational performance metrics.
- Coordinated resources across departments to maximize productivity levels.
- Ensured that KPI metrics are being met consistently monthly and year to date
Manager Pre-Access
Ensemble Health Partners
02.2020 - 12.2021
- Company Overview: Formerly Ballad Health
- Monitor and implement practices to meet KPI(s)
- Bring outlying areas into Pre-Access scope for prior authorizations
- Review areas of opportunities to reduce denials
- Review DNBI report daily for VA and infusion claims
- Review surgical post procedure change work queue daily to ensure if an authorization change is needed it is obtained
- Manager of two supervisors and 61 associates
- Well versed in chemo, surgery, diagnostic, cardiopulmonary, and radiation authorization requirements and submissions
Legacy WMA Central Referral Department Manager
Ballad Health
Bristol, USA
11.2015 - 02.2020
- Continually develop and implement policies and practices that are beneficial to the patient and provider that increases provider satisfaction rate while increasing our revenue
- This includes ensuring all radiology tests are scheduled within a 48 hour window, all prior authorizations for hi tech imaging are obtained to prevent write-offs, having orders changed in situations where Medicare will not cover the diagnosis and triggers the ABN waiver, and also ensuring follow ups of specialty referrals within one week in which my staff have not been notified of an appointment
- Develop methods that work efficiently for both the provider and department which enables the department to excel positively with positive patient feedback
- Maintain the work queue at all times to ensure that all offices remain up to date on referrals and are not behind
- Collaborate with practice managers on feedback from patients whether positive or negative and respond immediately to any patient complaints
Patient Account Representative II
Bristol Regional Medical Center
Bristol, USA
05.2015 - 11.2015
- Appealed denials of hospital claims
- Contacted patients to update COB
- Appealed and won the denial of the Holston Valley Imaging Center Denials for MRI’s and CT scans which saved the hospital $1.8 million dollars
- These claims had been sitting dormant for seven months prior to me sending a written appeal to the department of Medicaid in Nashville
- Worked closely with other departments including physical therapy, occupational therapy, MD Pre-cert team to obtain retro authorizations for claims where there was no prior authorization on file to avoid write offs
- Adjusted codes that insurance companies would not cover including J codes and NDC
Front Office I
Holston Medical Group
Webber City, USA
11.2014 - 05.2015
- Completed the registration of patients upon their arrival to their scheduled appointment
- Ran insurance to determine coverage and benefit amount including remaining out of pocket amount
- Answered incoming calls and returned patient calls
- Called patients to confirm appointments
- Communicated with doctors and nurses throughout the day regarding patient inquiries
- I left my part time position at HMG as it was only part time and I needed full time
Education
Bachelors of Science - Healthcare Administration
King University
Bristol, TN01.2016
Medical Records Technician -
Mountain Empire Community College
Big Stone Gap, VA01.2012
Skills
- Microsoft Visual Basic
- HTML
- Microsoft Office
- Microsoft Windows
- Adobe PhotoShop
- Adobe Illustrator
- Task delegation
- Business strategy
- Hiring and retention
- Creativity and innovation
- Relationship building
- Team building
- Staff management
- Charismatic leader
- Multitasking and organization
- Verbal and written communication
- Business administration
- Strategies and goals
- Team management
- Process improvement
- People management
- Issues resolution
- Leadership development
- Strategic planning
Certification
CRCR, HFMA
Accomplishments
- 11 years of experience in Healthcare including direct patient care, administrative support, claim denials, precertification, front office duties, and most recently management
- Promoted to Manager of the Centralized Referral Department(s) in Bristol and Norton in 02/2016
- Promoted to Manager, Pre-Access in 02/2020
- Aided in the development and implementation of both central referral departments.
- Successfully tracked and reduced leakage to external providers, which increased the amount of referrals that went to endocrinology in Bristol and also to Ballad Health Radiology imaging instead of Holston Medical Group.
- For more than two years I have supervised the central referral departments which now have eighty percent of the Legacy Wellmont Medical Associates Providers.
Locations
- Bristol, Bristol, TN
- Norton, Norton, VA
- Big Stone Gap, Big Stone Gap, VA
Timeline
Director, Pre-Access
Ensemble Health Partners
12.2021 - Current
Manager Pre-Access
Ensemble Health Partners
02.2020 - 12.2021
Legacy WMA Central Referral Department Manager
Ballad Health
11.2015 - 02.2020
Patient Account Representative II
Bristol Regional Medical Center
05.2015 - 11.2015
Front Office I
Holston Medical Group
11.2014 - 05.2015
Bachelors of Science - Healthcare Administration
King University
Medical Records Technician -
Mountain Empire Community College