Jordan M. Sells
Ector,TX
Summary
Knowledgeable of system integration and user training that enhances overall operational efficiency and user satisfaction. Experienced with application development, troubleshooting, and user support, utilizing technical expertise to diagnose and resolve software issues, ensuring optimal performance. Having a track record of maintaining accurate records and delivering exceptional customer service. Experienced with processing diverse insurance claims and ensuring compliance with regulatory standards.
Overview
10
10
years of professional experience
Work History
Program Application Specialist
Department of Veterans Affairs
10.2020 - Current
- Coordinates ongoing data collection and analysis and uses knowledge of SharePoint and Excel to determine organization performance.
- Provide continuous business oversight for a variety of software programs important to the overall administration and operations of the business and effect programmatic changes at the facility level.
- Serve as advisor on one or more regional groups, determining functionality and correct operations of application patches as it affects regional operations.
- Assign and maintain laptops for 100 employees, focusing on updates and access for each one.
- Develop reporting solutions for data requests and leadership updates and assist in administering data.
- Assists in preparation of various types of reports and briefings on application functionality and performance, to include claim payment data, resolve conflicting data, creating new or adjusting old methods to analyze findings.
- Conduct business process modeling, projects and studies impact on overall functions of the services in such areas as policy development and implementation, processes, streamlining, etc.
- Demonstrates knowledge and expertise in various programs Microsoft Office, Google, and various other programs.
- Skilled in making clear, concise, and effective oral and written reports and presentations.
- Supports non-clinical staff by providing training, participating in software testing and implementation from the user standpoint, working with users with specific applications, and troubleshooting operational problems.
- Interpersonal skills to favorably interact with a wide variety of individuals ranging from subordinate financial staff to headquarter program officials to exchange or present information and interpret policies and procedures.
- Regular conferences and meetings with departmental personnel, VHA management/leadership as well as VISN management/leadership. Interacts professionally with a variety of people including Non-VA staff, other non-VA compliance managers, facility leadership and VISN leadership.
- Assisted in the development of product documentation, creating easy-to-follow user guides and manuals.
- Increased customer satisfaction ratings through prompt resolution of technical issues via phone, email, or onsite assistance.
Customer Service Specialist
Department of Veterans Affairs
07.2019 - 10.2020
- Take in and adhere to complaints, grievances and other requests for information from Veterans or from individuals acting on behalf of the Veteran.
- Investigates all complaints, initiates action/appeals or change to rectify the situation and reports corrective measures taken to parties involved. When necessary, revising and recommending changes in instructional methods to better serve the community needs.
- Performing as the contact person for claimants and vendors seeking services or payment or reimbursement for services provided under the Community Care Program.
- Regular meetings with provider representatives of customer organizations to obtain information and provide resources and guidance pertaining to the processing of community care claims, and to respond to questions and concerns from the providers.
- In depth research of White House Hotline and Congressional inquiries forwarded to the Office of Community Care- Payment and Operations Management. Requires extensive knowledge of the healthcare industry and all VA regulations, laws, and policies. Prepares and presents conclusive responses and recommendations based on advanced analysis to operations officials.
- Shares information and analytics with team members and cooperates and coordinates with all center employees when processing a wide variety of requests.
- Process a broad variety of Veterans claims, to include Medical UB & HCFA, Dental, Bowel & Bladder, Contract Nursing Home, and Pharmacy Claims.
- Managed high call volume while maintaining a courteous and professional demeanor.
Lead Voucher Examiner
Department of Veterans Affairs
01.2019 - 07.2019
- Processes a broad variety of medical claims to include hospital, professional, dental, bowel & bladder, contract nursing home, and pharmacy.
- Reviews claims for error, fact, or law, based on the submission of additional factual or medical documentation to resolve a Vendor or Veteran issue.
- Verify accuracy and adequacy of documents or claims to ensure compliance with regulations and justifications for veterans.
- Assisted in new hire training and the development of refresher courses for current employees, modifying them when necessary. Regularly met with upper management to revise and adapt training courses and discuss the need for future developments.
- Regularly attends meetings and conferences and was an instrumental part of formulating training materials due to having extensive knowledge and expertise in the process.
- Traveled to vendor forums to meet with provider representatives and deliver group and individual instruction and training on a broad variety of topics.
- Called upon by management to train new Lead Voucher Examiners and select and develop training aids and standard operating procedures to be utilized by future new hires.
- Utilized knowledge of processing and suggested specific training needs and the effectiveness of a variety of methods being tested within the payment center.
- Provide information that helps in the development and evaluation of dispositions on reconsiderations related to the Office of Community Care.
- Daily reporting to include duplicate payment reports, (payment errors), and Supervisor Review (duplicate payments or invalid payments amounts). These reports help identify errors before the finalization of the payment.
- Create vendor reports using Tax IDs to provide claim status and processing information.
- Administering reports for individual Voucher Examiners processing queues, to maintain precision and timeliness, working with management and directors to coordinate appropriate queue management training to staff.
- Complete weekly audits for accuracy of claims processed, paid, rejected, or denied. When errors are found, I take the time to sit and explain the solution with the processor.
- Conducting individual training, along with group training and demonstrations. Created guides for new policies that were put into place, to better the flow of our processes.
- Consider all complaints of timely payments and initiate action/appeals to remedy the situation and pass on corrective measures taken.
- Coordinates meetings with representatives of customer organizations to obtain information to others.
- Attending and assisting in Vendor Fairs, to update and explain new processes of the Rules, Laws and Regulations of our services.
Voucher Examiner
Department of Veterans Affairs
10.2015 - 01.2019
- Responsible for the review and processing of all claims received within the Office of Community Care payment center.
- Ability to adequately review and resolve complex Non-VA care claims.
- Received phone calls from representatives of customer organizations on a broad variety of topics and situations, obtaining information and responding to verbal and non-verbal cues.
- Reconciles Other Health Insurance payments with varied adjustments for dates of service and applies financial laws, regulations, manuals, procedures, and practices regarding entitlement to payment of all types of invoices and claims.
- Ensures that the Agent Cashier functions within Fiscal Service are in full compliance with regulations.
- Review EOBs from major insurance providers.
- Reviewed the submission of Reconsiderations/Notices of Disagreement after the submission of additional documentation.
- Research, interpret and applied data processing codes to various areas of processing and payment systems to interpret computer printouts and detect errors in initial input.
- Processed claims in a timely fashion, meeting and exceeding production requirements set forth by leadership.
- Selected by management to help train new employees prior to the hiring of a permanent training specialist. Instrumental in the demonstration and development of guides and tutorials to aid in the training process.
- Selected to evaluate and test the effectiveness of training and development programs by management to ensure understanding and relevance.
Education
High School Diploma -
Dodd City ISD
Dodd City, TX01.2008
Skills
- In depth research skills
- Knowledge of regulations and guidelines
- Training and guiding staff
- Payment Operations Management
- Board membership
- Leadership
Timeline
Program Application Specialist
Department of Veterans Affairs
10.2020 - Current
Customer Service Specialist
Department of Veterans Affairs
07.2019 - 10.2020
Lead Voucher Examiner
Department of Veterans Affairs
01.2019 - 07.2019
Voucher Examiner
Department of Veterans Affairs
10.2015 - 01.2019
High School Diploma -
Dodd City ISD
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