Jennifer Saia-Costa
Tewksbury,MA
Summary
Dynamic Revenue Cycle professional with extensive experience at Steward Health Care, excelling in claims processing and management. Proven track record in insurance appeals and team leadership, driving compliance and efficiency. Adept at utilizing Microsoft Excel for data analysis, fostering collaboration to resolve complex claims issues effectively.
Overview
21
21
years of professional experience
Work History
DENIALS & AR ANALYST II
R1 RCM
10.2024 - Current
- Investigated denial reasons to determine optimal course of action for claims resolution.
- Contacted insurance companies to verify denial reasons and track appeal statuses.
- Collaborated with hospice facility representatives to resolve claims issues efficiently.
- Oversaw hospice claims worklist to facilitate efficient claims processing. to resolve outstanding claims.
- Communicate any changes in claims processing with management effectively to ensure prompt payments.
REVENUE CYCLE TEAM LEAD
Steward Health Care
06.2023 - 10.2024
- Audited accuracy of Revenue Cycle Associates' claim processing to ensure compliance and minimize errors.
- Conducted training sessions for Revenue Cycle Associates, providing guidance on effective claims handling.
- Trained new hires on standard operating procedures for MassHealth denials, facilitating smooth onboarding and knowledge transfer.
- Work with other departments to accurately resolve coding and authorization denials from MassHealth.
- Collaborated with manager on diverse claims-related projects to enhance workflow efficiency.
REVENUE CYCLE ASSOCIATE
Steward Health Care
04.2021 - 06.2023
- Compiled documentation and drafted appeals or 90-day waivers for denied MassHealth claims.
- Investigated denial reasons to determine optimal course of action for claims.
- Work with other departments to determine best course of action of inpatient level of care denials from MassHealth.
- Collaborated with supervisor and manager on projects related to claims resolution.
- Work post pay and prepay claims audit by Permedion to ensure timely filing and payment.
REIMBURSEMENT REPRESENTATIVE
Kabafusion
12.2020 - 04.2021
- Compiled documentation and wrote appeals for denied claims to secure approvals.
- Made outgoing calls to insurance companies to verify claim and appeal status, reprocessing claims denied in error.
- Investigated denial reasons to determine optimal course of action on claims.
AMBULANCE BILLING SPECIALIST
Cataldo Ambulance Services
07.2019 - 11.2020
- Handled incoming patient calls to resolve billing inquiries and collect payment information, enhancing patient satisfaction.
- Select proper ICD-10 codes for claims and bill to appropriate insurance following billing guidelines.
- Tracked and followed up on MassHealth MCO insurance claims to ensure timely processing and reimbursement.
- To follow up with MassHealth on claims submitted and resubmit corrected claims on MMIS.
- Review collections accounts to verify accuracy of billing prior to sending claim to collections.
- Submitted appeals for denied claims to secure necessary reimbursements. to MassHealth or MassHealth MCO, call insurance companies to have claim issues resolved.
PFS DENIAL SPECIALIST II
Lahey Clinic Hospital
02.2017 - 07.2019
- Made outgoing calls to insurance companies to verify claim and appeal status, ensuring accurate reprocessing of incorrectly denied claims.
- Investigated denial reasons to determine effective course of action for claims resolution.
- Compile documentation and write appeal for denied claims.
- Supported supervisor in managing various claims projects. and manager on various claims related projects.
ED BILLING SPECIALIST-TEAM LEAD
Logix
12.2015 - 01.2017
- Conducted quality audits on accounts, providing actionable feedback on incorrectly processed claims.
- Resolved issues with missing payment checks by coordinating with insurance companies. to insurance companies to stop and reissue missing payment checks.
- Reviewed coding requests and forwarded them to the coding department for further evaluation.
- Answer team questions concerning claim processing, in-house protocols and guidelines.
ED BILLING SPECIALIST
Logix
04.2014 - 12.2015
- Utilized in-house computer programs for accurate claims processing, enhancing overall billing efficiency.
- Contacted insurance providers for clarification on claim denials, facilitating resolution of denial statuses.
- Verified billing and completed mailing process to ensure timely delivery of claims.
- Verifying appeals are properly completed and mailing out.
BILLING OFFICE SUPERVISOR
Lifeline Ambulance Company
08.2013 - 04.2014
- Input patient demographic information into the computer system.
- Select proper ICD-9 code for claims.
- Followed up on denied Medicare claims, facilitating timely redeterminations.
- Researched and addressed customer inquiries regarding billing issues.
- Audited trip sheets and delivered feedback to crews for correction on inaccuracies.
COLLECTIONS REPRESENTATIVE
Lifeline Ambulance Company
05.2012 - 08.2013
- Secured pre-authorizations for non-emergent claims, facilitating timely processing.
- Called insurance companies to verify status of pending claims.
- Sent redetermination requests to various insurance companies for claims that were denied.
- Investigated claims that had no insurance listed to locate active insurance.
- Ran in-house reports identifying outstanding claims for follow up.
EMERGENCY MEDICAL TECHNICIAN-BASIC (EMT-B)
Lifeline Ambulance
09.2011 - 05.2012
- Delivered basic life support care following Lifeline Ambulance protocols and medical direction
- Assessed patient condition and documented vital signs during Lifeline Ambulance transports
- Responded to emergency calls, delivering calm support to patients and families during critical situations.
- Coordinated tasks effectively in high-pressure situations, maintaining composure and focus to ensure optimal patient care.
- Communicated patient status to dispatch, hospitals, and emergency response teams, ensuring timely and accurate information transfer.
- Completed patient care reports and transfer paperwork for Lifeline Ambulance records
EMERGENCY MEDICAL TECHNICIAN-BASIC (EMT-B)
Redd's Ambulance
01.2010 - 01.2011
- Assessed patient condition and documented vital signs during Redd's Ambulance transports
- Provided basic life support care in accordance with Redd's Ambulance protocols and medical direction, ensuring patient safety and well-being
- Communicated patient status clearly with dispatch, hospitals, and emergency response teams
- Completed patient care reports and transfer paperwork to maintain accurate medical records and facilitate seamless patient handoffs
- Responded to emergency calls, offering calm support to patients and families to alleviate stress during critical situations
- Managed multiple tasks simultaneously while remaining calm under pressure.
EMERGENCY MEDICAL TECHNICIAN-BASIC (EMT-B)
Armstrong Ambulance Service
09.2005 - 05.2010
- Delivered basic life support care in accordance with Armstrong Ambulance protocols to stabilize patients during transport.
- Assessed patient condition and documented vital signs during Armstrong Ambulance transports
- Communicated patient status to dispatch, hospitals, and emergency response teams to ensure coordinated care.
- Completed patient care reports and transfer paperwork for Armstrong Ambulance records
- Responded to emergency calls and provided calm support to patients and families
- Managed various responsibilities efficiently during emergency situations. simultaneously while remaining calm under pressure.
Education
Bachelor's Degree - Healthcare Administration
Merrimack College
Andover05-2027
Paralegal Certificate -
Middlesex Community College
Lowell, MA05-2025
Associates Degree - Healthcare Administration
Middlesex Community College
Lowell, MA05-2023
Medical Billing and Coding -
US Career Institute
Dracut, MA01-2021
EMT-B - Emergency Medical Technician Certificate
American Medical Response
Worcester, MA01-2004
Skills
- Claims processing
- Claims management
- Insurance appeals
- Claims analysis
- Medical billing
- Revenue cycle management
- Healthcare compliance
- Microsoft Excel
- Team leadership
Timeline
DENIALS & AR ANALYST II
R1 RCM
10.2024 - Current
REVENUE CYCLE TEAM LEAD
Steward Health Care
06.2023 - 10.2024
REVENUE CYCLE ASSOCIATE
Steward Health Care
04.2021 - 06.2023
REIMBURSEMENT REPRESENTATIVE
Kabafusion
12.2020 - 04.2021
AMBULANCE BILLING SPECIALIST
Cataldo Ambulance Services
07.2019 - 11.2020
PFS DENIAL SPECIALIST II
Lahey Clinic Hospital
02.2017 - 07.2019
ED BILLING SPECIALIST-TEAM LEAD
Logix
12.2015 - 01.2017
ED BILLING SPECIALIST
Logix
04.2014 - 12.2015
BILLING OFFICE SUPERVISOR
Lifeline Ambulance Company
08.2013 - 04.2014
COLLECTIONS REPRESENTATIVE
Lifeline Ambulance Company
05.2012 - 08.2013
EMERGENCY MEDICAL TECHNICIAN-BASIC (EMT-B)
Lifeline Ambulance
09.2011 - 05.2012
EMERGENCY MEDICAL TECHNICIAN-BASIC (EMT-B)
Redd's Ambulance
01.2010 - 01.2011
EMERGENCY MEDICAL TECHNICIAN-BASIC (EMT-B)
Armstrong Ambulance Service
09.2005 - 05.2010
Bachelor's Degree - Healthcare Administration
Merrimack College
Paralegal Certificate -
Middlesex Community College
Associates Degree - Healthcare Administration
Middlesex Community College
Medical Billing and Coding -
US Career Institute
EMT-B - Emergency Medical Technician Certificate
American Medical Response