Joanna D. Acevedo
Tucson,AZ
Summary
Proven leader with a track record of successfully managing teams and projects, driving performance improvements, and achieving organizational goals. Dedicated professional with extensive experience in coordinating activities in high-pressure environments. Proficient in Accounts Payable, Accounts Receivable, and general bookkeeping procedures. Highly skilled communicator with a talent for building strong relationships with colleagues and stakeholders to achieve organizational goals. Known for effectively managing multiple tasks within strict timelines, anticipating needs, and prioritizing duties efficiently. Recognized as a ‘go-to’ resource for delivering results, offering a unique blend of thought leadership, innovative ideas, and project planning expertise.
Overview
11
11
years of professional experience
Work History
Manager Provider Relations
Centene Corp
11.2021 - Current
- Establish and nurture relationships with members of the physician’s network of managed care service providers, and review billing and claims payments in accordance with managed care contracts.
- Manage Provider Relations Specialists staff in day-to-day performance; guarantee department milestones and goals are met within the department and among staff.
- Monitor performances with tracking and establish corrective measures as needed and prepare detailed reports.
- Function effectively as a resource and ‘go-to’ person to physicians, answering questions and providing information on network procedures and contracts; Keep an open and effective communication line, and provide clear and concise answers as it pertains to each task.
- Effectively managed and resolved complex provider issues by leveraging strong analytical and communication skills. Demonstrated ability to identify root causes, develop strategic solutions, and implement corrective actions to ensure seamless operations. Maintained positive relationships with providers through proactive communication and negotiation, ensuring high levels of satisfaction and compliance with organizational standards.
Claims Supervisor
Centene Corp
02.2019 - 11.2021
- Identified operational process improvement opportunities and directed the implementation of outlined improvements in order to meet contractual compliance.
- Facilitated communication with the health plan vice president to ensure consistent alignment with specified guidelines and compliance —the ability to work well with others as an essential high-level leader.
- Provided assistance and support in employee retention, promotion, and termination activities. Developed and provided performance evaluation and goal-setting activities.
- Conducted extensive research on regulations and requirements using contract specific to each state the claims department supported. Aided in the development of best practices to optimize claims processing quality.
- Developed and provided comprehensive daily reporting to management and health plans that detailed compliance, TAT, and operational gaps.
- Drafted and issued summaries of department updates to internal customers of each health plan. Created and implemented pend burn-down plans.
Lead Claims Analyst
Centene Corp
02.2018 - 02.2019
- Assisted the supervisor in daily duties whenever the management team was short-staffed; monitored attendance, watched claims inventory, monitored quality, and assisted with people management issues for 24 analysts.
- Assisted the supervisor in conducting research audit reviews and internal audits for state-specific processing and aided with workflow updates and changes for claims processing based on state guidelines.
- Updated analyst’s profiles and access according to business needs. Point of contact for IL and IN assessed inventory and delegated duties accordingly.
- Responded to and appropriately handled emergency situations that arose calmly and effectively with the ability to change the approach or method to fit the situation best.
- Ran CenPAS and Microstrategy Ad Hoc reports weekly.
- Served as the primary contact for the team for any claim issues and claims research, oversaw claims quality research, and reviewed for accuracy.
Claims Analyst
Centene Corp
07.2017 - 02.2018
- Process physician and hospital claims according to policy and provider contract.
- Access computer systems to research and determine status of medical claims and processing.
- Review charges using workflows, payment and denial codes within established departmental and state guidelines.
- Determine member health insurance coverage to coordinate member benefits.
- Assist, educate, and mentor new training classes in the understanding of claims processing guidelines for new hire classes.
Medical Billing Specialist
Copperstate OBGYN
11.2016 - 07.2017
- Spearheaded an aging project and championed the team, resulting in timely payment on claims. Developed necessary reports to ensure aging statuses were worked on in a timely manner.
- Researched and resolved claim-related issues to receive maximum client profitability and reviewed claims to ensure payer-specific billing requirements were met.
- Collaborated with payers to resolve issues in a timely manner and collaborated with subordinates and managers to assist in collecting data on root causes and denial prevention procedures.
- Collaborated harmoniously and productively with front office staff to ensure the proper information was received for accurate claims processing.
Patient Financial Services
Banner Health Center
01.2016 - 03.2016
- Provided support and assistance with member communication to ensure understanding of their provider bill and patient rights.
- Employ an understanding of AHCCCS payment policies and the impact on members and providers in submitting claims to AHCCCS.
- Developed statements requesting additional patient information and/or balances on accounts.
- Reviewed claims for proper and accurate submission through the clearing house, corrected claim edits, and resubmitted through the house for processing.
- Responded to all requests to analyze time or billing information and statistics. Followed up on clients weekly and monthly with a variety of insurance carriers.
Reimbursement Specialist/ Logging
Shared Services Center Tucson
11.2014 - 12.2015
- Verified CPT and ICD 9 for various specialties and corrected CPT and ICD 9 codes according to Medicare Guidelines for accurate reimbursement. Ensured accurate level of service and physician’s diagnosis in addition to various other CPT codes.
- Billed patient claims for services rendered in a physician’s office; specialties ranged from family medicine, pediatrics, dermatology, radiology, laboratory, rheumatology, and obstetrics.
- Applied appropriate transaction lines to account and changed financial class to ensure the flow of claims in AR. Identified payer variances based on contracts and payer requirements and communicated discrepancies in the payer log.
- Worked on the daily transaction by payer report timely on hospital and ancillary claims and monitored reimbursement activity to identify trends and irregularities.
Education
Bachelor of Arts - Healthcare Administration
University of Phoenix
Masters - business administration
University of Phoenix
Skills
- Claims Resolution
- Complex Issue Resolution
- Effective Communication
- Billing Processes
- Process Enhancement
- Motivational Leadership
- Staff Management
- Innovative Thinking
- Dependability & Flexibility
- Attention to Detail
- Multitasking & Prioritizing
- Strategic Planning
- Resource Allocation & Optimization
- Claim Management
- Concept Development
- Custom Onboarding Training Development
- Cross Functional Collaboration
CORE COMPETENCIES
- Interpersonal Skills: Excellent communication skills via e-mail, over-the-phone, and in-person. Maintains professionalism, especially in high-pressure situations. Can positively and successfully diffuse a stressful situation.
- Critical Thinking: Use resources to make responsible decisions in a high-energy environment, adapt quickly to change, time management, and prioritize tasks to meet deadlines.
- Analytical/Decision Making: Able to quickly analyze metrics and analytics to weigh out the best possible options before making decisions to achieve profitable results.
- Communication: Equipped with interpersonal communication skills and able to smoothly blend and interact with top management, peers, and teams from diverse backgrounds.
Drive Projects/Tasks Through Prioritization Workflow
- Assigned Task
- Organization
- Prioritization
- Alignment
- Initiation & Implementation
- Task Completion
Timeline
Manager Provider Relations
Centene Corp
11.2021 - Current
Claims Supervisor
Centene Corp
02.2019 - 11.2021
Lead Claims Analyst
Centene Corp
02.2018 - 02.2019
Claims Analyst
Centene Corp
07.2017 - 02.2018
Medical Billing Specialist
Copperstate OBGYN
11.2016 - 07.2017
Patient Financial Services
Banner Health Center
01.2016 - 03.2016
Reimbursement Specialist/ Logging
Shared Services Center Tucson
11.2014 - 12.2015
Bachelor of Arts - Healthcare Administration
University of Phoenix
Masters - business administration
University of Phoenix
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