Jessika Benevides
Bethlehem,PA
Summary
Experienced insurance specialist with a strong expertise in provider insurance enrollment. Demonstrates a comprehensive understanding of enrollment processes, credentialing, and compliance requirements. Skilled in managing provider networks, facilitating smooth onboarding, and ensuring accurate and timely enrollment. Known for exceptional organizational abilities, attention to detail, and effective communication skills. Dedicated to maintaining high standards of accuracy and efficiency to support healthcare providers and optimize their participation in insurance plans.
Overview
19
19
years of professional experience
Work History
Supervisor of Provider Enrollment
LVHN
06.2022 - Current
- Monitors staff performance, reviews workflow processes, and identifies opportunities to drive greater efficiencies
- Coaches, counsels, and mentors staff members in effort to develop staff and improve teamwork, morale, and overall results
- Responsible for reviewing applications, interviewing applicants, hiring, counseling of employees productivity/behavior and involved in the dismissal process of an employee
- Performs annual Performance Evaluations and bi-annual performance check ins with all 18 direct reports
- Responsible to hold 1:1 touch base with employees to ensure employees are in an adequate place professionally, performance level and moral level
- Supervises the submission of payer applications/linking letters and handles the follow up with both providers and payers throughout the application process to minimize revenue delay and revenue loss
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
- Partners with the analytical team to develop workflows, processes, and procedures to address file maintenance and updates
- Facilitates the timely enrollment of providers and the appropriate release of denial claims
- Maintains accurate spreadsheet to identify claims on hold/dollars by provider /payor combination
- Leads team efforts in developing solutions in complex situations to ensure goals and objectives are met
- Promotes 'best practices' for the day-to-day workflow and enforces standardization to drive maximum efficiencies
- Participates in maximizing the reimbursement by ensuring accurate and timely system set up and data input to ensure that provider credentialing application and link letters can be submitted to the contracted payers on time
- Identifies the potential for process improvements by tracking trends to bring to the attention of management
- Monitors performance/ productivity for accuracy and timeliness and initiates workflow enhancements to increase productivity and quality
Provider Enrollment Liaison
LVHN
04.2022 - 06.2022
- Performs all Provider enrollment specialist process functions
- Participates in the Provider enrollment workflow planning, implementing, and following-up on new acquisitions on the Provider/Practice enrollment applications while effectively communicating enrollment status to related departments
- Works with the Epic analyst concerning Provider builds and Epic workflows relating to provider participating approval status and the release of claims to maximize revenue capture
- Coordinated multiple projects simultaneously, ensuring timely completion and alignment with organizational objectives.
- Served as the primary point of contact, fostering strong relationships between internal teams and external partners.
Practitioner Specialist
LVHN
11.2021 - 04.2022
- Manages and facilitates the preparation, sending, and receiving of all membership agreements and employment agreements for physicians and APCs
- Manages and facilitates the onboarding of new physicians and APCs
- Follows-up and assists providers in pre-employment activities (pre-employment physicals, HR briefing, orientations, etc.)
- Ensures that all providers are credentialed with medical staff and all pre-employment items are completed prior to start date
- Maintains and updates compensation and dictionary databases for all providers
- Collaborates with compensation analysts to monitor and audit compensation database entries on a regular basis to ensure accuracy
- Serves as a resource to all physicians and APCs regarding benefits and status of employment
- Provides education and support to practitioners and leaders throughout the evaluation process
- Produces reports and analysis for performance evaluation results
- Supports data needs from other departments around performance evaluation
- Produces high-quality, precise legal documents with leadership
Revenue Cycle – Enrollment Specialist
LVHN
08.2019 - 10.2021
- Provider and Payer Enrollment Specialist - Enrolling providers with all payers, delegated and non-delegated payers, working hand in hand with Practice support specialist and Practice managers when issues arise with providers not being par with a payer
- Documenting and updating all required locations
- Have overseen two major clean up projects with two different payers which provided par statuses for over 100 providers
- Updated, entered, and reviewed provider data.
- Communicated effectively via telephone, email, and in person with prospective providers.
- Enhanced customer service by promptly addressing inquiries and resolving issues in a timely manner.
Insurance Coordinator
LVHN-LVPG Neurology
08.2017 - 08.2019
- Obtaining prior authorizations for high dollar infusions therapy, out of network radiology testing, as well as in network studies
- Providing information and knowledge to PSR staff to ensure patient satisfaction with all things that would require or include the patient's insurance
- Front end check in & out, new patient scheduling, return patient scheduling
- Assists with medical records, telehealth, insurance authorizations, working with the Scheduling Coordinator, rescheduling patients and other duties as assigned
- Verified insurance and communicated coverage to staff and patients.
- Managed a high volume of inbound calls, promptly resolving issues while providing accurate information on policies and procedures.
- Assisted clients with understanding complex insurance policies, effectively addressing concerns or questions.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
Team Lead. Surgery Scheduler
Easton Hospital/ Shared Service Center
11.2010 - 08.2017
- Along with responsible for scheduling appointments for radiology studies, verifying insurance is eligibility, and confirming medical necessity meets when required
- Pre-Registering patient’s appointments
- Documenting all the necessary information needed for the patient’s appointment
- Going to different practices, training practice employees with their onboarding and assisting when needed
- Trained new team members by relaying information on company procedures and safety requirements.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
- Coached team members in techniques necessary to complete job tasks.
Human Resources Coordinator
HB Trucking
06.2005 - 06.2014
- Responsibilities included creating and maintaining accounts payable and accounts receivable for family trucking company as well as seeking and negotiating future business contracts
- Scheduling drivers to work
- Responsible with payroll
- Maintained human resources information system and kept employee files up to date and accurate.
- Conducted new employee onboarding and provided ongoing orientation training.
- Supported HR functions with emphasis on record keeping, data entry, and general HR tasks.
- Completed background and reference checks to facilitate hiring and onboarding of employees.
Human Services Technician
Hagedorn Psychiatric State Hospital
07.2007 - 11.2010
- Responsible for the care and monitoring of Gero Psychiatric and Young Adult Psychiatric clients in addition to recording and maintaining medical and behavioral documentation
Education
Bethlehem Catholic High School
Bethlehem, PA06-2004
Skills
- Training and mentoring
- Insurance Processes and procedures
- Priority management
- Microsoft Experience
- Meticulous attention to detail
- Adaptability
- Advanced Excel spreadsheet functions
- Medical terminology expertise
- Prior authorization processing
- Interviewing
- Microsoft 365 software
- Investigative research
Timeline
Supervisor of Provider Enrollment
LVHN
06.2022 - Current
Provider Enrollment Liaison
LVHN
04.2022 - 06.2022
Practitioner Specialist
LVHN
11.2021 - 04.2022
Revenue Cycle – Enrollment Specialist
LVHN
08.2019 - 10.2021
Insurance Coordinator
LVHN-LVPG Neurology
08.2017 - 08.2019
Team Lead. Surgery Scheduler
Easton Hospital/ Shared Service Center
11.2010 - 08.2017
Human Services Technician
Hagedorn Psychiatric State Hospital
07.2007 - 11.2010
Human Resources Coordinator
HB Trucking
06.2005 - 06.2014
Bethlehem Catholic High School