Hi, I’m
Jessica R. Dorn
Health Care Professional
Winter Garden,FL
Summary
Organized and dependable candidate champion for quality improvement initiatives with a successful track record of managing multiple priorities and concerns over 15 years. Enthusiastic about team success and passionate about details.
Overview
16
years of professional experience
Work History
AdventHealth
ACO REACH Program Manager
03.2021 - 11.2023
Job overview
- Managed administrative and daily program operations, complying with state and federal policies and regulations.
- Identified program obstacles and communicated possible impacts to team.
- Developed, maintained and socialized logistics workflows, procedures and reports.
- Managed multiple strategic projects with numerous sub-projects or workstreams.
Humana Care Delivery
Clinical Compliance Officer
03.2019 - 03.2021
Job overview
- Conducted multi-level audits on medical provider documentation and billing practices.
- Developed Corrective Action Plans using technical, clinical, and statistical data following a compliance audit
- Drove field discussions with medical providers and office staff focused on documentation requirements and quality care-gaps.
- Developed and deployed training tailored to individual medical providers who were in violation of clinical documentation requirements.
- Collaborated with internal and external stakeholders, auditors and legal counsel to confirm compliance with applicable laws and regulations.
- Reviewed, revised and updated compliance policies and procedures to confirm continual compliance with applicable laws.
Humana Insurance Company
Investigations Audit Professional
07.2014 - 03.2019
Job overview
- Sub-lead a team of 15 offshore auditors.
- Collaborated with leaders to cross train on and offshore business partners on Claims Cost Management and Fraud, Waste and abuse processes.
- Developed training material and audit process step-actions for the aforementioned Claims Cost Management and Fraud, Waste and abuse processes.
- Conducted technical and analytical reviews of complete Special Investigations cases to aid in determining on-going training needs.
- Conducted on and offshore audits and implemented processes that improved quality by 40%.
- Provided a time-analysis to determine the staffing and training needs of the Special Investigations Unit.
Humana Insurance Company
Special Investigator
07.2009 - 07.2014
Job overview
- Collected, analyzed and interpreted information, documentation and medical records associated with investigations from customers and medical providers and staff.
- Prepared case reports from allegations, transcripts of interviews and case findings and delivered results to executive leadership and regional medical or dental directors.
- Managed to completion an average caseload of 25-30 cases efficiently and effectively.
Humana Insurance Company
Customer Service Champion
07.2007 - 07.2009
Job overview
- Actively listened to customers, promptly handled concerns and escalated major issues appropriately.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Sought ways to improve processes and services provided by developing and implementing a quality incentive program.
Education
Silver Lake CollegeManitowoc, WI
Bachelor of Science from Business
12.2009
Skills
- Quality Audit
- Data Analysis, Collection & Research
- Training and Development
- Policy and Procedure Improvements
- Relationship Building
- Organizational Performance
- MS Office Applications
- Versed in CPT, ICD-10 and ADA
Timeline
ACO REACH Program Manager
AdventHealth
03.2021 - 11.2023
Clinical Compliance Officer
Humana Care Delivery
03.2019 - 03.2021
Investigations Audit Professional
Humana Insurance Company
07.2014 - 03.2019
Special Investigator
Humana Insurance Company
07.2009 - 07.2014
Customer Service Champion
Humana Insurance Company
07.2007 - 07.2009
Silver Lake College
Bachelor of Science from Business