Jerusha Durrani
Madison,WI
Summary
Results-oriented high-performing Analyst skillful in managing and breaking down large volumes of information. Proactive at heading off issues in operations, workflow and production by uncovering trends affecting business success.
Overview
16
16
years of professional experience
Work History
Encounters Analyst
Molina Healthcare
05.2023 - Current
- Focused on analyzing complex Wisconsin Medicaid encounter inbound/outbound process issues, using data from internal and external sources to provide insight to decision makers.
- Reduced denied Coordination of Benefit encounter denials with the state by 33% within 4 months hire.
- Analyzes a Paid/Pend/Denied report for top Molina providers and presents at monthly meetings with stakeholders at different hospital systems to educate and partner on proper billing practices and Molina guidelines.
- Serves as a primary source of contact for all Molina providers regarding complex claim issues and large exception/settlement requests.
Senior Provider Network Consultant
Dean Health Plan By Medica
02.2019 - 05.2023
- Senior role was focused on identifying and resolving large claim issues for assigned provider (SSM Health Hospitals and Clinics in Wisconsin) as well as collaborating with other PNC's when there is a claims impact for the rest of the network. This includes pulling reports, analyzing data and working with internal teams to provide a solution for our providers.
- Primary point of contact for Keystone project under leadership. Worked with Medica and DHP staff to review DHP business rules for deployment of Health Rules to replace Metavance.
- Created over 50 new training documents for re-design of new hire onboarding. This included creating cheat sheets, manuals, PowerPoint presentations, system walk throughs and other training documents. Primary trainer for DHP claim systems to new and existing employees. One of the primary trainers for new hires, focusing on provider set up, claim system training and provider appeals.
- Performs all duties of PNC that are listed below as well as other duties upon assignment.
Provider Network Consultant
Dean Health Plan
11.2015 - 02.2019
- Served as a consultant between DHP’s provider network and DHP’s internal departments (Provider Data & Configuration, Utilization Management, Medical Affairs, Contracting, Credentialing, Customer Service Center & Coding) to facilitate payment of claims and upholding DHP’s policies.
- Led provider facing meetings for training, annual visits, and to go over concerns with processes.
- Worked as a liaison between contracting and credentialing to ensure that all information is accurate and set up correctly in claims system and directory for new and existing providers
- Researched and completed all provider appeals for no authorization and timely filing denials, utilizing own judgment as well as DHP guidelines to make fair and unbiased decisions for upwards of 50% of the total department appeals.
Customer Service Representative
Dean Health Plan
07.2013 - 11.2015
- Received inbound calls, answering eligibility, claim, benefit and general questions for members and providers for all DHP product lines (Commercial, Self-Funded, Medicare and Medicaid)
- De-escalated upset callers, while being empathic and understanding while researching possible solutions to come to an agreeable course of action.
- Helped train new team members as a subject matter expert in training classes as well as being a trusted resource for questions.
- Worked on the Assist Line to help with questions from reps that were on active calls.
- Served as an on-site clinic representative on a fill-in basis to assist members face to face.
Personal Banker
Associated Bank
06.2012 - 02.2013
- Performed teller transactions as well as identified customer needs and matched them to the appropriate financial solutions, using strict company guidelines for conversation to sell various additional services.
- Day to day responsibilities included cash vault balancing/auditing, tracking and servicing ATM machines and night drops, balanced cash daily with minimal to zero errors.
- Mock-audited branch to be prepared for unexpected audits.
- Passed all required compliance training with a focus in identifying fraud if suspected.
Inside Sales Representative
National Business Furniture
06.2011 - 02.2012
- Took inbound sales calls for high-end office and home furniture with sales at approx $300K monthly.
- Maintained a list of leads and responsible for ensuring leads are explored and closed.
- Stayed abreast of new furniture lines with ongoing training on new products and materials.
- Maintained a high order accuracy rate of 100%.
- Responded to general email, faxes, furniture sample requests and W-9 inquiries.
Customer Service Representative
DonJoy Orthopedics
01.2008 - 10.2010
- Answered over 100 calls per day to place orders for orthopedic line of products with provider offices, sales representatives, and the general public
- In addition, served as a Bone Growth Stimulator technician to answer all questions regarding use of the product as well as troubleshoot malfunctions
- Extensive knowledge of the orthopedic product line and had ongoing training for new products
- Data entry of paper purchase orders with high attention to detail.
Education
High School Diploma -
Rancho Buena Vista High School
Vista, CA06.2003
Skills
Commercial
Medicare & Medicaid
Excel
Problem Solving
Training
Presentation skills
Medical Terminology
Timeline
Encounters Analyst
Molina Healthcare
05.2023 - Current
Senior Provider Network Consultant
Dean Health Plan By Medica
02.2019 - 05.2023
Provider Network Consultant
Dean Health Plan
11.2015 - 02.2019
Customer Service Representative
Dean Health Plan
07.2013 - 11.2015
Personal Banker
Associated Bank
06.2012 - 02.2013
Inside Sales Representative
National Business Furniture
06.2011 - 02.2012
Customer Service Representative
DonJoy Orthopedics
01.2008 - 10.2010
High School Diploma -
Rancho Buena Vista High School
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