JENNIFER DAVIS
CAR
Santa Fe,NM
Summary
Detail-oriented professional with 20+ years of experience handling a variety of insurance claims in fast-paced environments. A highly driven problem-solver skilled in delivering outstanding customer service by leveraging strong communication, interpersonal, and relationship building skills. Key strengths include AR reimbursement, appeals, denial management, and overturning denied claims. Knowledgeable leader and dedicated problem solver. Brings 20+ years of valuable expertise to forward any companies objectives. Attentive to detail with experience in coordinating projects, programs and improvements.
Overview
18
18
years of professional experience
Work History
Customer Access Representative
Presbyterian Medical Services
07.2023 - Current
- Improved patient satisfaction by efficiently managing appointment scheduling and registration processes.
- Enhanced hospital revenue by accurately verifying insurance coverage and collecting payments for services rendered.
- Reduced wait times with prompt communication between patients, providers, and insurance companies.
- Maintained accurate patient records, ensuring timely access to vital information for healthcare professionals.
- Collaborated with multidisciplinary teams to provide exceptional care and a positive experience for patients.
- Contributed to the facility''s reputation for quality care by consistently exceeding customer service expectations through prompt assistance and problem resolution efforts.
- Proficient in NextGen software.
DENIAL AND APPEALS SPECIALIST (REMOTE)
Presbyterian Healthcare Services
08.2013 - 04.2023
- Perform accounts receivable reimbursement analysis and denial management activities for HMO, PPO, Veterans Affairs, ChampVA, TriWest and Tricare payer accounts using monthly aged account work queues and/or A/R reports.
- Responsible for tracking, appealing, and resolving denied claims, as well as analyzing reimbursements according to contractual agreements.
- Contacted 10+ insurance companies, patients, and employers daily regarding outstanding claims, using a courteous and professional demeanor while providing timely follow-up.
- Overturned 20% of denied claims, contributing to $80,000 in revenue, by providing accurate information, including appeals, medical records, itemized statements, etc
- Required by insurance companies.
- Ensure that all job functions are performed within the established quality and quantity standards
- Adhere to all PHS and Patient Accounting Department policies and procedures to promote a smooth working environment and uphold the PHS vision by practicing the CARES behaviors at all times.
FUNDS AND COLLECTIONS REMITTANCE PROCESSOR II
SEIU 32BJ FUNDS
12.2005 - 07.2012
- Verify and assure accuracy of benefit calculations, figures & cash posting to remittance reports and BONY, CHASE lock box batch contents.
- Demonstrate proficiency in all benefit fund processes including but not limited to processing AUDITS, Statement of Accounts, (SOA), Pension claims, 401K, Employer Stipulation, Adjustment billing, Applied/Unapplied Credits, Refunds, and Bounced Checks.
- Daily Batch reconciliation to lock box ledgers of accounts receivable payments.
- Research, interpret and analyze employer contracts to reconcile batches and provide employer education.
- Prepare spreadsheets/reports on employee work history such as pension (retirement) claims etc.
Billing and Collections Coordinator
Planned Parenthood of NM
- Reconciliation of all EOB's and aged receivables; Processes also include the review, correction and entry of all claims via electronic/manual transmission to various insurance providers from Medicaid to 3rd Party Payers and Medicare.
- Implemented the finance depts
- Patient Liability recoupment process.
- Facilitated training of all new/current staff and clinicians on PPNM correct CPT coding and, billing initiatives.
- Maintain monthly expenditure reports for reimbursement from B&CC program and NMCSAP (Breast & Cervical; NM Coalition of Sexual Assault).
Education
Associate OF Science (A.S.) in Health Science (Pre-Pharmacy) -
South College
05.2023
Skills
- NextGen
- Accounts Payable and Accounts Receivable
- Accounts Payable and Receivable Auditing
- Past Due Balance Management
- Claims Adjustments
- Filing Appeals
- Insurance Plan Verification
- Healthcare Terminology
- Diagnostic Codes
- Account Issues
- Policy and Procedure Explanations
- Insurance Calculation
- Call Center
- Payment and Investigation Escalations
- Policy Requirements and Eligibility
- Billing Software
- Secure Data Practices
- Customer Satisfaction
- MAC Proficient
- EPIC
- Multiple Insurance Provider Portal Access
- Critical Thinking
- Complex Problem Solving
- Microsoft Office Programs
- Sharepoint
- Nthrive
- Authorization
- HIPAA Compliant
- Project Management
- Contract Management
- Database Management
- Recordkeeping
Accomplishments
Summa Cum Laude Graduate at South College in Knoxville, TN with a 3.93 GPA
Awards Recognitions Volunteer Work
Summa cum laude GPA 3.93, South College Dean's List
Timeline
Customer Access Representative
Presbyterian Medical Services
07.2023 - Current
DENIAL AND APPEALS SPECIALIST (REMOTE)
Presbyterian Healthcare Services
08.2013 - 04.2023
FUNDS AND COLLECTIONS REMITTANCE PROCESSOR II
SEIU 32BJ FUNDS
12.2005 - 07.2012
Billing and Collections Coordinator
Planned Parenthood of NM
Associate OF Science (A.S.) in Health Science (Pre-Pharmacy) -
South College