JENNIFER RUSH
Bend
Summary
Dynamic professional with experience in medical office settings, adept at leveraging a broad skill set in medical billing, claims management, and appeals. Proven track record of driving business development success year-over-year while consistently achieving objectives through a results-focused and quality-driven approach. Recognized for exceptional customer service skills and meticulous attention to detail, ensuring alignment with organizational goals. Expertise in maintaining high recovery rates of accounts receivable, demonstrating a commitment to excellence and consistency in production.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Manager, Reimbursement and Appeals
Naveris
Waltham, MA
01.2023 - 04.2026
- Managed integration of new RCM software vendor and acted as key liaison for vendor-related activities. Oversaw maintenance of payor mapping EDI functions, payor enrollments, and credentialing initiatives.
- Optimized cash flow through the development of workflows addressing payor trends.
- Oversaw comprehensive transition of front-end processes and appeals, ensuring seamless integration into in-house operations.
- Achieved seamless management of commercial Medicare Advantage and state Medicaid enrollments. Facilitated effective Medicare enrollment and maintenance via PECOS. Maintained Sam.gov registration for maintenance government contracts.
- Maximized performance by monitoring daily activities and mentoring team members.
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
- Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Established team priorities, maintained schedules and monitored performance.
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
Manager, Reimbursement and Appeals
LucidDx Labs, Inc.
Lake Forest, CA
05.2023
- Currently managing pre-claim and post-claim activities. Payor initial enrollments, ERA, and EFT registration for Commercial and Government payors. Work with Quadax through billing software implementation and legacy A/R. Work closely with laboratory staff regarding billing processes. Maintain insurances with addresses in LIMS and Quadax company profile. Attend weekly operations meetings with Quadax to ensure software implementation is running smoothly. Collaborate with Quadax where process improvement may be needed. Determine the need for and request updated billing information. Answer patient hotline calls regarding coverage, pricing, and patient responsibility. Manual insurance verification when needed. Interview and train billing staff.
- Remote
Office/Shop Floor Manager
Dacaero, LLC.
Sunriver, OR
02.2020 - 08.2023
- Assembly of fixtures and tooling for CH47 Helicopter Fire Suppression System function and maintenance, project management, purchasing, inventory, accounting, payroll, filing of quarterly state withholding tax, generation of invoices and purchase orders, shipping (domestic, international, small and large freight), receiving, other tasks as required.
Appeals Team Lead/Appeals Process Analyst
Invitae Corporation
Irvine, CA
08.2021 - 05.2023
- Primary responsibilities and duties included overseeing day-to-day operations of reimbursement and appeals. Creating billing initiatives to increase and maintain revenue. Identifying reimbursement issues and trends and suggesting potential improvements. Managing and maintaining quality across the billing department. Implementing and executing process development. Analysis of accounts receivable and DSO reduction. Establishing and monitoring payor revenue projects. Implementation of Xifin appeal automation across payor groups. Developed and trained appeals team Medicare Advantage appeal process. Coordination of hiring, training, and coaching staff. Team building. Experience using Xifin billing software platforms, Word, Excel, Google Apps, Microsoft Apps, Mac OS X, SalesForce, BackOffice, LIMS, and CRM applications.
- Remote
Production Assistant
Kawak Aviation Technologies, Inc.
Bend, OR
10.2018 - 02.2020
- Assembly and riveting of CH47 and Blackhawk Helicopter Fire Suppression Systems, assembly and riveting of Helicopter Logging Grapple Chassis, assembly of multiple versions of Throttle Quadrants for agricultural aircraft, applied for and secured state small business grants through Oregon’s STEP (State Trade and Export Promotion Program), Coordinated and booked international Aerospace and Aviation trade shows, assisted with presentation of documentation for First Article Certification of parts with the FAA, invoicing, receiving, shipping (domestic, international, small and large freight), other tasks as required.
Senior Grievance and Appeals Coordinator
CareDx, Inc.
Brisbane, CA
01.2016 - 06.2017
- Full understanding and utilization of each level of Medicare, Medicare Secondary, Medicare Advantage (Low payment/Full Denial), Commercial Payer (Low payment/Full denial), and Member appeal guidelines. Assistance in drafting of appeal letters to Commercial and Federal payers regarding Experimental/Investigational and Not Medically Necessary denials. Collectively created an Appeals Flowchart to best capture all steps necessary for a favorable appeal outcome. Payer trend analysis and ad-hoc reporting using Telor software. Heading of Payer claim and appeal projects to maximize practice receivables. Obtained information surrounding External Review and Independent Review availability for the Patient Advocacy Department. Negotiation of Letters of Agreement with payers to obtain uniform payment terms for multiple cases. Tracking of Payer positive coverage limitations (i.e., Eff date, pricing, clinical coverage limitations)
Team Lead– Billing and Remittance
Premier Source Diagnostics - AmerisourceBergen Consulting Services
Charlotte, North Carolina
07.2011 - 01.2016
- Management of diagnostic patient cases from enrollment to case resolution. Assisting patients and providers with issues related to diagnostic billing and reimbursement. Daily job functions included; elite customer service, generation of patient statements, maintenance of A/R, payer trend projects, medical claims submission, claim/appeal resolution, management of multiple clients while maintaining caseload and assisting the operational team with updating process flows and standard operating procedures.
Patient Account Representative
UW Medicine-Northwest Hospital and Medical Center
Seattle, Washington
10.2010 - 03.2011
- Daily management of patient accounts and patient demographic requests, daily use of EMR, generation of patient statements, collection of payments, utilization of a multitude of commercial and government insurance websites for coverage verification, maintenance of A/R through self-pay and balance after insurance report analysis. Worked with patients to resolve balances through setting up payment plans or offering financial assistance through the hospital’s charity assistance program. Collection of bank statements, previous tax returns, and pay vouchers to support financial need. Accounts receivable posting, customer service and billing, additional responsibilities involved creating ad-hoc reports and developing process improvements.
Medical Claims Analyst/Clinical Editing
Blue Care Network
Grand Rapids, Michigan
06.2009 - 06.2010
- Responsibilities involved daily utilization of CPT, HCPCS, ICD-9, the National Correct Coding Policy Manual for CCI Claim Check edits, McKesson, BCBSM Crosswalk, Ingenix Encoder Pro, FACETS, Imax-Macess applications, and EMR review for processing denials or overturns of appeals submitted with clinical edits. Primary duties as a Medical Claims Analyst were to support clients with the accurate and timely filing of electronic or paper healthcare claims. This included verifying electronic submissions, determining reasons for claim or file rejections, review of clinical documentation to determine decision of appeal, and resolving claim rejection issues.
Reimbursement Specialist
Walgreens – Option Care: Home Infusion Services
Coopersville, Michigan
08.2007 - 06.2009
- Job duties involved daily processing of delivery tickets for in home infusion, electronic submission of claims using Zirmed after locating appropriate drug and procedure codes, look up of NDC and drug pricing to calculate correct J code units to be billed, handling of accounts receivable and recovery of payments through status review or appeal process for Blue Care Network of Grand Rapids and BCBSM Home Infusion Therapy contracts. Responsibilities also involved patient statements, billing Medicare for denial, and secondary billing with remit from Medicare. Position required daily use of MRO-Chart Online, Electronic Filing Cabinet, Web Denis, Remit Data, and Microsoft Excel spreadsheets.
Director, Reimbursement
Naveris/CareDx
Brisbane, CA
03.2026 - Current
- Analyzed reimbursement processes and established performance metrics to support informed decision-making.
- Facilitated training sessions for junior staff to enhance skills in claims management and appeals navigation.
- Demonstrated agility in adapting strategies while maintaining focus on objectives.
- Designed and executed training programs for internal teams on complex reimbursement protocols and guidelines.
- Orchestrated strategic communication with payers to secure beneficial terms and resolve conflicts in a timely manner.
- Analyzed and refined reimbursement processes, resulting in improved revenue growth and operational efficiency.
- Created detailed training resources for billing and coding staff, aimed at improving adherence to best practices and overall efficiency.
- Advised on complex reimbursement challenges, facilitating effective solutions for both internal teams and external partners.
- Analyzed performance metrics to assess alignment with departmental goals and executed adjustments to enhance overall success.
- Coordinated with other departments, such as finance and legal, to address cross-functional issues related to healthcare reimbursement.
- Led a successful appeal process against denied claims by effectively presenting supporting evidence.
- Implemented training initiatives for reimbursement team members, reinforcing a commitment to continuous learning and career growth.
- Attended industry conferences and educational events to remain informed about evolving healthcare reimbursement strategies.
- Formulated and implemented comprehensive reimbursement policies to enhance claims processing efficiency.
- Analyzed and refined reimbursement workflows, leading to increased productivity and operational effectiveness.
- Analyzed financial data to identify opportunities for revenue enhancement within existing contracts or potential business partnerships.
- Established and checked coding procedures, monitored reports and updated internal files.
- Evaluated historical records and operational data to uncover and implement opportunities for system improvements.
Education
Human Services, Psychology
Baker Community College
Nursing, Medical Insurance Billing
Muskegon Community College
Diploma - undefined
North Valley High School
Grants Pass, ORCRMS -
American Medical Billing Association
2026
Skills
- Medical Claim and Appeal Analysis
- Trouble Shoot Claim Rejection
- HIPAA Compliant
- Payer/Insured Relations
- Understanding of ICD-9/10 and CPT
- Service Strategies/Solutions
- Electronic/Paper Billing
- Understanding of HCPCS
- Team Training & Mentoring
- Electronic Chart Review
- A/R, Recovery of Receivables
- 10,000 KSPM, 70WPM
Certification
- CMRS - Certified Medical Reimbursement Specialist
Timeline
Director, Reimbursement
Naveris/CareDx
03.2026 - Current
Manager, Reimbursement and Appeals
LucidDx Labs, Inc.
05.2023
Manager, Reimbursement and Appeals
Naveris
01.2023 - 04.2026
Appeals Team Lead/Appeals Process Analyst
Invitae Corporation
08.2021 - 05.2023
Office/Shop Floor Manager
Dacaero, LLC.
02.2020 - 08.2023
Production Assistant
Kawak Aviation Technologies, Inc.
10.2018 - 02.2020
Senior Grievance and Appeals Coordinator
CareDx, Inc.
01.2016 - 06.2017
Team Lead– Billing and Remittance
Premier Source Diagnostics - AmerisourceBergen Consulting Services
07.2011 - 01.2016
Patient Account Representative
UW Medicine-Northwest Hospital and Medical Center
10.2010 - 03.2011
Medical Claims Analyst/Clinical Editing
Blue Care Network
06.2009 - 06.2010
Reimbursement Specialist
Walgreens – Option Care: Home Infusion Services
08.2007 - 06.2009
Nursing, Medical Insurance Billing
Muskegon Community College
Diploma - undefined
North Valley High School
Human Services, Psychology
Baker Community College
CRMS -
American Medical Billing Association