JOHNNY JANDRES

• Trained and experienced in the effective claims processing for Nevada Medicaid/Medicare, DHMOs
• PPOs, Florida Medicaid, Illinois and various local programs
• Provide correct approval and denial (PEC) codes to provider for the purpose of avoiding resubmissions and minimize errors
• Exceed daily claim processing requirements while at the same time meeting other business demands
• Audit and review claims processed by the data entry team for accuracy
• Process multiple lines of business as required by claims department
• Re-submit claims for all lines of business in a timely manner to meet resubmission deadlines
• Review daily aging report to maintain updated on demands of all lines of business
• Confirm figures that are being submitted by provider are accurate and true to contract guidelines

Responsible for overseeing Claims staff, managing inventory turnaround times and

deadlines, and creating and distributing daily and weekly reports to staff and Director. Monitors and

redistributes work load as needed, fosters staff development, supports and displays a teamwork

atmosphere, and improves department morale. Work directly with front line staff to ensure processing guidelines are followed and clients’ Service Level Agreements (SLAs) are

achieved.

• Assisted in the recruitment and selection of new claims adjusters, ensuring they possessed the necessary skills and expertise to excel in their roles.
• Monitored performance metrics regularly, identifying areas for improvement and implementing corrective measures accordingly.
• Fostered a positive work environment that promoted collaboration, teamwork, and open communication among staff members.

• Maintained updated and detailed records of calls in physical and electronic database.
• Planned, organized, and managed work of subordinate staff to accomplish consistent work within organizational standards.
• Closely monitored dispatch board
• Dispatch appropriate engineering team member and or public services personnel.
• Monitor the fire board and security system
• Active/deactivated fire alarms

• Greeted customers with smile and provided friendly, knowledgeable service.
• Assisted patrons with seating by giving directions and lighting paths.
• Directed ticket holders to seats and facility locations.