Karimah Jones
Philadelphia
Summary
Seasoned Managed Care Analyst with over a decade of progressive experience in payor policy tracking, reimbursement analysis, and managed care contracting. Proven ability to interpret and operationalize complex payor contracts, consistently identifying and resolving revenue cycle barriers to enhance financial performance. Skilled in fostering cross-functional collaboration that strengthens compliance and revenue streams while ensuring the delivery of high-quality patient care. Committed to driving operational efficiencies within healthcare organizations to support sustainable growth and success.
Overview
10
10
years of professional experience
Work History
RCM Managed Care Analyst
Envision Physician Services
03.2020 - Current
- Serve as primary point of contact for payor policy interpretation, ensuring internal teams understand and follow contractual terms across 80+ health plans.
- Partner with Health Plan Relations to manage escalated payor issues, mitigate revenue cycle barriers, and ensure resolution aligns with contract terms.
- Design and lead the Payor Policy Update Program, delivering monthly updates on payor guidelines, coverage changes, and reimbursement models to leadership and operational teams.
- Collaborate with legal, finance, and access teams to implement new and renewal contracts, track changes, and monitor compliance post-implementation.
- Conduct SQL-based reimbursement analyses and summarize findings into actionable recommendations for leadership.
- Provide operational insight and market intelligence on new plan offerings to identify strategic and financial opportunities.
Intermediate Reimbursement Analyst
Envision Physician Services
03.2017 - 03.2020
- Oversaw CMS Medicare Quality Payment Program compliance for 600+ practices, interpreting policy updates and guiding providers to meet program requirements.
- Forecasted reimbursement impacts from policy changes, mitigating penalties and maximizing incentive payments.
- Delivered contract and policy education sessions to physicians and administrative staff, improving compliance and operational efficiency.
Associate Reimbursement Analyst
Envision Physician Services
06.2016 - 03.2017
- Maintained payer/procedure tables to ensure alignment with contractual reimbursement terms.
- Resolved payment discrepancies and escalated payer compliance issues to leadership.
- Conducted research and analysis to support contract management and operational improvements.
Education
Bachelor of Science - Biology
Millersville University of Pennsylvania
Millersville, PA01.2014
Skills
- Implementation of managed care agreements
- Health plan relations management
- Payor policy analysis & tracking
- Medical billing and coding (ICD10)
- Claims resolution expertise
- Expert in CMS regulations
- Microsoft Office
- MS Excel
- SQL and databases
- Revenue performance
- Billing cycle management
Timeline
RCM Managed Care Analyst
Envision Physician Services
03.2020 - Current
Intermediate Reimbursement Analyst
Envision Physician Services
03.2017 - 03.2020
Associate Reimbursement Analyst
Envision Physician Services
06.2016 - 03.2017
Bachelor of Science - Biology
Millersville University of Pennsylvania
PROFESSIONAL INVOLVEMENT
- Wellness Champion
- Promote clinician wellness, mental health resources and workplace balance