Jessica Dillard
North Little Rock,AR
Summary
Results-driven leader with over 15 years in business management and 7 years in medical billing and claims. Expertise in streamlining operations, reducing costs, and enhancing documentation processes. Proven track record of increasing efficiency and profitability while managing multiple tasks in fast-paced environments. Skilled in business analysis, technology implementation, and project management with a strong focus on delivering actionable solutions.
Overview
14
14
years of professional experience
Work History
Professional Business Analyst II
Gainwell Technologies
09.2020 - 06.2025
- Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities.
- Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates.
- Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design.
- Assists in developing and modifying systems requirements documentation to meet client needs.
- Participates in meetings with clients to gather and document requirements and explore potential solutions.
- Executes systems tests from existing test plans. Assists in analyzing test results in various phases.
- Participates in technical reviews and inspections to verify 'intent of change' is carried through phase of project.
- Analyze Medicaid provider contracts, pricing, designs, configures provider agreements, configuration validation, configuration peer review.
- Updating Medicaid provider contracts, procedures codes pricing rates, procedures codes billing and reimbursement rates, and revenue codes pricing data.
- Creating individual case agreements with facilities and providers.
- Creating and analyzing Medicaid medical billing claims to verify if updates are properly made in the system.
- Communicate design to all stakeholders and varying levels of the organization.
- Present and evaluate design solutions objectively and facilitate conflict resolution.
- Define, use, and communicate design patterns and best practices in service-oriented analysis, design, and development.
- Configure new and revised claims adjudication logic within a healthcare claims system.
- Configure products / benefits, providers agreements, fee schedules, and claims payment rules.
- Configure Claim Adjustment Reason Codes and Remittance Advice Code.
- Quality assurance and testing within health plan configuration system (e.g., Facets) to ensure configuration is ready for implementation.
- Collaborate with quality assurance team to ensure testing efforts align with system deliveries and business processes.
Senior Account Manager/ Medical Biller
Baptist Health
08.2019 - 09.2020
- Prepares and submits clean claims to third party payers either electronically or by paper.
- Assure coding is compliant and up to date.
- Maintains relationship with clearinghouse, including appropriate follow-up with support issues.
- Coordinate the process of patient eligibility through various third-party sources.
- Coordinate collection process, to include any projects from Medisoft accounts and tracking current collections in eClinicalWorks.
- Manage monthly statement process, to include reviewing statements before mailing and field any patient inquiries the Patient Services staff needs to escalate.
- Coordinate and administer policy and procedure for sliding scale.
- Work with reception staff, ensure appropriate collection of co-pays, spend down and self-pay fees.
- Handles patient inquiries and answers questions from clerical staff and insurance companies.
- Identifies and resolves patient billing problems.
- Denial and insurance follow-up management.
- Issues adjusted, corrected, and/or rebilled claims to third party payers.
- Posts adjustments, transfer of responsibility and refunds, as necessary.
- Reviews accounts and makes recommendations to the Controller regarding non collectible accounts.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Maintain up-to-date credentials for each licensed provider, including verification through primary and secondary sources, records, and relay credentialing information to relevant personal as needed.
- Keeps accurate records of provider licensure/ certification renewals.
- Assist Human Resources in vetting prospective providers as needed, provide appropriate information so that CEO and Board of Directors can complete the privileging process.
- Coordinate provider enrollments in all commercial, state and federal insurance programs.
Managed Care Account Representative/ Denials Specialist
Baptist Health
06.2017 - 08.2019
- Maintained accurate and timely collections of balances to ensure a balanced deposit each day.
- Communicated with patients, faculty, students, insurance companies and other departments to resolve patient accounts.
- Resolved system reports such as aged accounts receivable and unallocated payments report.
- Answered patient questions, inquiries and concerns regarding their accounts.
- Trained new employees on all aspects of Patient Account Representative responsibilities and a staff trainer for Epic, Health Logic, and SSI.
- Handled invoice billing complaints and discrepancies, issuing credit memos when necessary.
- Researched and reconciled customer accounts/invoices to ensure accurate and timely billing.
- Prepared summary sheets and manual invoicing whenever necessary.
- Assisted clients with the collection of payments from outstanding accounts receivable on a monthly basis and obtained and matched PO numbers to delivery slips to ensure prompt receipt of payment.
Correspondence Representative Specialist ASE/PSE
Arkansas Blue Cross Blue Shield
09.2014 - 06.2017
- Prepare documents and correspondence such as damage claims, credit and billing inquiries, invoices, and service complaints.
- Compile data from records to prepare periodic reports.
- Review correspondence for format and typographical accuracy, assemble the information into a prescribed form with the correct number of copies, and submit it to an authorized official for signature.
- Respond to internal and external requests for the release of information contained in medical records, copying medical records, and selective extracts in accordance with laws and regulations.
- Compute costs of records furnished to requesters and write letters to obtain payment.
- Compose correspondence requesting medical information and records.
- Prepare records for shipment by certified mail.
- Obtain written authorization to access required medical information.
- Ensure that money collected is properly recorded and secured.
Customer Service Representative/ Claims Service Representative
Arkansas Blue Cross Blue Shield
09.2014 - 06.2017
- Review claims adjustments with dealers, examining parts claimed to be defective and approving or disapproving dealers' claims.
- Review insurance policy terms in order to determine whether a loss is covered by insurance.
- Contact customers in order to respond to inquiries or to notify them of claim investigation results and any planned adjustments.
- Check to ensure that appropriate changes were made to resolve customers' problems.
- Compare disputed merchandise with original requisitions and information from invoices and prepare invoices for returned goods.
- Complete contract forms prepare change of address records, and issue service discontinuance orders, using computers.
- Confer with customers by telephone or in person in order to provide information about products and services, to take orders or cancel accounts, or to obtain details of complaints.
- Determine charges for services requested, collect deposits or payments, and/or arrange for billing.
- Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
Case Analyst II/ Contracting Specialist
Transamerica Worksite Marketing
04.2011 - 04.2013
- Investigate and follow-through on contract issues.
- Enable and cooperate with departments like Legal, Operations, Credit and Accounting.
- Handle multiple projects in fast paced team environment.
- Create and communicate concise and consistent contract provisions.
- Judge and work under pressure and persuade parties in full fairness of company’s position.
- Communicate with co-workers and management on data input or file maintenance.
- Resolves administrative problems by coordinating preparation of reports, analyzing data, and identifying solutions.
Education
Master of Healthcare Administration -
Webster University
Little Rock, AR06.2018
Bachelor of Science - Business Management
University of Phoenix
Little Rock, AR04.2012
Skills
- Self Confidence
- Strategic Thinking
- Analytical Thinking
- Managing Change
- Personal Credibility
- Empowering Others
- Attention to Detail
- Building Collaborative Relationship
- Decisiveness
- Efficient in Oral & Written Communication
- InterChange
- EPIC
- Cerner
- Passport
- DME (Medicare billing system)
- Health Logic
- SSI (billing system)
- AHIN
- CSW
- ECM (medical records system)
- Amisys
- Amazon Workstation
- Application Lifecycle Management (ALM)
- Microsoft Office Suit
- Business process design
- Requirements gathering
- Data analysis
- Test scenario creation
- System documentation
- Claims processing
- Quality assurance
- Healthcare compliance
- Stakeholder communication
- Conflict resolution
- Project management
- Customer relationship management
- Attention to detail
- Analytical thinking
- Time management
- Information modeling
- Industry knowledge
- Predictive modeling
- Search engine optimization
- Stakeholder managementl
- Client relationship management
- Stakeholder management
- Test case scenarios
- Analytical tool implementation
- Operations analysis
- Microsoft Office Suite
- Risk assessment
- Customer targeting
- Workflow optimization
- Software development life cycle
- Strategic thinking
- Microsoft Excel mastery
- Competitive analysis
- Change management
- Product management
- Team collaboration
- User acceptance testing
- Workflow Analysis
- Systems analysis
- Reporting and documentation
- Verbal and written communication
- Change impact analysis
- Operational reporting
Affiliations
- Zeta Phi Beta Sorority Inc.
References
References available upon request.
Timeline
Professional Business Analyst II
Gainwell Technologies
09.2020 - 06.2025
Senior Account Manager/ Medical Biller
Baptist Health
08.2019 - 09.2020
Managed Care Account Representative/ Denials Specialist
Baptist Health
06.2017 - 08.2019
Correspondence Representative Specialist ASE/PSE
Arkansas Blue Cross Blue Shield
09.2014 - 06.2017
Customer Service Representative/ Claims Service Representative
Arkansas Blue Cross Blue Shield
09.2014 - 06.2017
Case Analyst II/ Contracting Specialist
Transamerica Worksite Marketing
04.2011 - 04.2013
Master of Healthcare Administration -
Webster University
Bachelor of Science - Business Management
University of Phoenix
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