Joyce Sneed
Danville,VA
Summary
I am seeking a customer service, claims processor, and pre-authorizations role in medical and dental scheduling where I can deliver timely, compliant appointment coordination, support patient needs with cultural sensitivity, and assist with health assessments and referrals. I have over 20 years’ experience in the health insurance industry.
Overview
8
8
years of professional experience
Work History
Facets Claims Processor
Hays Talent/Cognizant/VMAC
11.2024 - 01.2025
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Paid in accordance with CMS guidelines.
- Accessed CMS pricing charts determined by provider location.
- Facets Claims Processor, Medicare & Medicaid claims, Long term care, Inpatient facility claims, Home health claims, Anesthesia Pricing, Eligibility review, Ambulance claims.
Business Analyst
Metasis Information Systems Inc.
01.2023 - 03.2023
- Creating Epics using Jira application.
- Attended daily stand-ups using agile principles.
- Validating requirements with Business entities.
- Requirements updated in Power MHS.
- Validating Medicare Advantage and Medicaid benefits.
- Updated changes in the wording in MACESS letters.
- Reconfiguring letters for developers.
- Writing user stories and attaching new letters to send to the appropriate development teams.
- Identify the Letter Templates in MACESS.
- Added claims status in MACESS letters.
- Test letters, provide and update Epic and User story status updates and documents.
- Analyzed current healthcare information systems to identify integration points for HL7 implementation and Interoperability.
- Adhered to CMS guidelines.
- Upload letters to the Confluence repository.
Business Analyst
Pinnacle Tek LLC
03.2023 - 12.2023
- Creating Assessment, Analysis, Audit (AAA) View 360 application.
- Review state policies and current business rules to establish a design for contracts and benefits.
- Attended daily stand-up meetings.
- Update/edit configuration as needed.
- Review tickets/inquiries in ALM from the client.
- Validating CPT, HCPCS II, ICD-9, ICD-10, Revenue coding in QNXT configuration.
- Created test scenarios, created test cases for unit testing, and created claims for professional and institutional.
- Running SQL queries
Business Analyst
TEKsystems Inc.
08.2021 - 10.2022
- Validating deductible and out-of-pocket maximums.
- Updating Excel spreadsheets with data for overages.
- Requesting claims reprocessing using Change Gear.
- Ensure that payments were in accordance with DOFR.
- Validated benefits for HMO plans with capitation requirements in client's legacy system.
- Validated benefits to small and large commercial groups on the client's legacy system.
- Following HIPAA and CMS policies and procedures.
- Attending weekly conference calls.
- Validating data on Mental Health and Medical claims in the TEST environment.
- Created test cases for MACESS.
- Validate benefit configuration Power MHS for migration to QNXT.
- Validating CPT, HCPCS II, ICD-9, ICD-10, REV codes in QNXT configuration for claim testing.
- Creating test cases for QNXT migration for Medicaid and Medicare Advantage.
- Tracking done in MS Excel.
- Updating documentation and uploading to SharePoint.
- Created Test scenarios, Created Test cases for Unit Testing, Created claims for professional and institutional.
Business Analyst
Apex Systems Inc/Advantasure
04.2019 - 03.2020
- Validating test results, maintaining over 98% accuracy in the system.
- Validated pricing accuracy according to fee schedules.
- Validating benefits loaded in Amisys to prepare for conversion.
- Validate benefit files for BlueCard.
- Benefit configuration on Power MHS.
- Validated HMO capitation requirements.
- Medical, Dental, Vision, and some Pharmacy benefits were reviewed for accuracy.
- Validated the test scenarios and test cases in the IKA system.
- Validating CPT, HCPCS II, ICD-9, ICD-10, and Rev codes in configuration for claim testing.
- Validated claims for professional and institutional to ensure requirements were met.
- Identified and prioritized defects in the test environment.
- Tracking done with Jira and SharePoint.
- Received Online Certification assessments for HIPAA and CMS guidelines.
- BC/BS subsidiary
Sr. Denials Analyst/Revenue Cycle
Conifer Health Solutions
04.2017 - 02.2018
- Disputed payment amount with Insurers (Commercial, MVA, WC, VA, Medicare Advantage and Medicaid).
- Prepared for monthly inspection by the state for DOFR to ensure the hospital was compliant.
- Documenting past due accounts to Insurers and the Insured.
- Managed accounts using Revenue Cycle to reduce A/R and balance accounts using EPIC Tapestry.
- Reviewed contract agreements to ensure payments are made accordingly.
- Following HIPAA and CMS policies and procedures.
- Obtaining authorization for procedures using Epic Tapestry UM for insurance carriers.
- Creating referrals for specialists using Epic Tapestry.
- COB claims submitted to multiple carriers.
- Balance bills sent to secondary and tertiary insurance carriers or insured.
- Calculated network discounts and requested adjustments for underpayments to maintain a balanced budget.
- Analyzed business processes and workflows to identify areas for integration and improvement using HL7 and FHIR standards.
- Issued refunds for overpayments while providing medical records for further review by higher ups to facilitate exceeding annual objectives.
- Authorized payments for BlueCard.
- Submitting EHRs submitted for Medical Policy Review and authorization.
- Priced Inpatient claims prior to submission based on contractual agreement with payer.
- Demonstrated proficiency in submitting 270, 834, and 837 EDI transactions.
- Performed audits of subsidiaries to protect shareholders and potential investors from fraudulent or unrepresentative financial claims.
Education
BA - Psychology
Southern New Hampshire University
01.2024
Master of Science - Health Information Management
Southern New Hampshire University
Manchester, NH06.2026
Skills
- Medical Terminology
- Medical Benefits
- MS Word
- Excel
- Outlook
- Visio
- Agile
- Waterfall
- Good communication skills
- Team Player
- Reliability
- Multiple Claim and Benefit applications
- QNXT
- Facets
- Power MHS
- Amisys
Timeline
Facets Claims Processor
Hays Talent/Cognizant/VMAC
11.2024 - 01.2025
Business Analyst
Pinnacle Tek LLC
03.2023 - 12.2023
Business Analyst
Metasis Information Systems Inc.
01.2023 - 03.2023
Business Analyst
TEKsystems Inc.
08.2021 - 10.2022
Business Analyst
Apex Systems Inc/Advantasure
04.2019 - 03.2020
Sr. Denials Analyst/Revenue Cycle
Conifer Health Solutions
04.2017 - 02.2018
Master of Science - Health Information Management
Southern New Hampshire University
BA - Psychology
Southern New Hampshire University