Jonnia Draper
Fresno,CA
Summary
Analytical professional in the insurance investigation field known for high productivity and efficient task completion. Skilled in claim evaluations, regulatory state compliance, ensuring thorough and accurate case handling. Excel in communication, problem-solving, and decision-making, leveraging these soft skills to navigate workmen's compensation cases effectively and deliver optimal outcomes.
Overview
18
18
years of professional experience
Work History
Workers Compensation Specialist
Revecore
Fresno, CA
03.2024 - 06.2024
- Perform manual data entry of patient accounts and or claim forms
- Obtain bills, medical records or other necessary documentation from medical providers in a timely manner
- Review and edit claims to ensure they meet state and federal guidelines
- Submit claims timely and accurately to Medicaid payers
- Perform aggressive follow-up on unresolved claims
- Facilitate timely payment from Medicaid payers
- Research denials and/or underpayments and formulate appeal letters and/or disputes to Medicaid plans in accordance with state guidelines
- Submit payment details to the cash posting team
- Work in compliance with state and federal guidelines, including HIPAA and FDCPA
- Maintain case clear, concise and accurate account notation
- Monitor the status of accounts and communicate effectively with management, clients and other parties regarding the status of the accounts
- Provide responses to client inquiries within 24 hours
- Analyze and manage complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution
- Work closely with insurance companies and third-party payers to collect revenue for surgical and physical therapy services performed
- Contact employers, patients, or insurance carriers to confirm a report of injury is on file
- Submit medical claim forms and all medical reports to support processing for payment
- Review workers' compensation accounts against state-mandated schedules and guidelines; identify managed care contracts; review claims against applicable contracts; and submit any discrepancies for payment and appeals
- Negotiate settlements of Louisiana claims for implants used on inpatient surgical procedure within designated authority
- Calculate and assign ti
Lead Claims Examiner
Healthcare recovery alliance
Bryan, TX
01.2016 - 11.2022
- Analyze and manage complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim
- Manage claims through well-developed action plans to determine if claims are valid.
- Work closely for surgical and physical therapy services performed for authorization approvals, and to confirm the services are related to the claim.
- Review medical claim forms and all medical reports to support the level of services and confirm that they are related to the accepted injury.
- Manage workers' compensation accounts against state-mandated rules and guidelines.
- Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim
- Prepare appropriate filings to the state when applicable
- Remit payment within timely guidelines for medical bills confirmed to be related to accepted injury
Claims Specialist
Navigant Guidehouse
Remote
12.2020 - 09.2022
- Analyze and manage complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution
- Work closely with insurance companies and third-party payers to collect revenue for surgical and physical therapy services performed
- Contact employers, patients, or insurance carriers to confirm a report of injury is on file
- Submit medical claim forms and all medical reports to support processing for payment
- Review workers' compensation and commercial payer accounts against state-mandated schedules and guidelines; identify managed care contracts; review claims against applicable contracts; and submit any discrepancies for payment and appeals
- Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim
- Prepare necessary appeals following state filling guidelines, within statutory limits.
Account Representative
SMART START INC
Grapevine, TX
06.2015 - 12.2015
- Take inbound calls from customers with questions in regards to their accounts
- Process payments
- Process release per court or probation orders
- Set up installation and removal appointments
- Set up request for servicing.
Account Representative
Alorica for Verizon
Clovis, CA
06.2013 - 01.2015
- Take inbound calls from customers
- Process customers payments
- Process request to add additional services
- Report and track customer complaints
- Escalate calls to leadership.
Deli Clerk
Save Mart Supermarket
Fresno, CA
03.2006 - 03.2012
- Opening and closing department
- Replenish and rotate merchandise with items from stockroom
- Keep department safe, clean and sanitized to meet state regulations
- Tracking of supplies, inventory
- Train new employees in accordance to store policy
- Prepare hot and cold food
- Place customer order in store and over the phone.
Education
High School Diploma -
Furman High School
Madera, CA01.2006
Skills
- Microsoft Office
- Bill Auditing
- State appeals
- Customer Service
- Medical billing
- Reading EOB
- 10 Key Data Entry
- CPT Coding
- Workers' Compensation
- ICD-10
- Multi-line Phone Systems
- Insurance Verification
- HIPPA
- Commercial Insurance
- Excellent customer service skills
- Self-motivated and dependable
- Epic
- Typing
- Medical Records
- Accounts Receivable
- State jurisdictions TX, NC, LA, CA VA
- UB04 and HCFA 1500
- UB04 and HCFA
- Medical terminology
- Workers' compensation law
- Microsoft Excel
- Analysis skills
- ICD-9
- Revenue cycle management
- Windows
Workauthorization
Authorized to work in the US for any employer
Additional Information
Experienced in medical billing for commercial and workers compensation.
Knowledgeable with reading and understand explanation of benefits.
Well rounded with filing appeals with insurance and also filing state medical fee disputes.
Experienced with commercial billing and various commercial online portals for quick and sufficient status updates.
Assessments
- Protecting patient privacy, Proficient, 07/01/22
- Medical billing, Proficient, 07/01/22
Personal Information
Willing To Relocate: Anywhere
Timeline
Workers Compensation Specialist
Revecore
03.2024 - 06.2024
Claims Specialist
Navigant Guidehouse
12.2020 - 09.2022
Lead Claims Examiner
Healthcare recovery alliance
01.2016 - 11.2022
Account Representative
SMART START INC
06.2015 - 12.2015
Account Representative
Alorica for Verizon
06.2013 - 01.2015
Deli Clerk
Save Mart Supermarket
03.2006 - 03.2012
High School Diploma -
Furman High School