Jocylynn Jackson

• Reviewed and processed medical claims to determine primary and secondary payer responsibility.
• Verified member eligibility and other insurance coverage to ensure accurate claim adjudication
• Investigated and corrected COB discrepancies to prevent duplicate or incorrect payments.
• Ensured compliance with CMS regulations and HIPAA standards.
• Maintained productivity and quality metrics in a high-volume processing environment.
• Contacts members, providers, or other insurance carriers to confirm coverage details.
• Ensures compliance with CMS, Medicaid, or Marketplace regulations.
• insurance information in claims processing systems with high accuracy.

• Proactively identifies and reports claim payment discrepancies, including overpayments and underpayments, helping to reduce financial risk and support accurate claims resolution.
• Conducts in-depth review of complex and high-dollar claims beyond standard adjudication levels, ensuring correct processing, benefit interpretation, and adherence to compliance standards.
• Utilized computers and computer systems (including hardware and software) to program, write software, set up functions, enter data or process information

Performs claim rework calculations to correct payment discrepancies and ensure accurate benefit determination

• Applies medical guidelines to determine coverage, complete eligibility verification, identifies discrepancies, and applies all cost containment measure to complete the adjudication process.

• Accurately document detailed benefit information, including cost-share responsibilities (deductibles, co-pays, coinsurance) and provider access options to support care coordination.
• Collect and review all required patient insurance details to ensure complete and accurate benefit verification, minimizing delays in the treatment process.
• Identify prior authorization requirements, coverage restrictions, and potential barriers to treatment; collaborate with stakeholders to expedite patient access to care.
• Verify patients’ insurance eligibility, coverage limits, and benefit details by coordinating directly with insurance carriers and healthcare providers.