KENYADA JONES
Houston,TX
Summary
Healthcare operations professional with over 8 years of experience in revenue cycle management and healthcare IT systems. Demonstrated success in optimizing workflows and ensuring regulatory compliance, resulting in enhanced operational efficiency. Expertise in Epic EHR system and healthcare technology integration. Open to remote opportunities in healthcare IT or business process consulting.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Appeals and Grievances Coordinator
CENTENE CORPORATION
Woodland Hills, CA
01.2017 - 01.2020
- Resolved escalated customer complaints through thorough research and stakeholder coordination.
- Investigated denial and non-payment trends identified by Revenue Cycle Analytics team.
- Processed aged claims and appeals using payer portals and outbound phone calls.
- Followed up with members to deliver case dispositions and clarify complex information.
Family Caregiver
Georgia Career Break
Atlanta, Georgia
01.2020 - 02.2022
- Relocated to Georgia to provide full-time care for my mother during COVID-19 pandemic. Maintained healthcare industry knowledge through professional development and returned to workforce in healthcare operations.
Dissector
ARTIVION
Kennesaw, GA
03.2022 - 11.2023
- Dissected and processed human tissues, documenting activities to support analysis.
- Received, inspected, and labeled incoming tissue to ensure quality compliance.
- Evaluated tissue for acceptance according to established quality standards.
- Maintained a clean workspace by routinely disinfecting processing areas and equipment.
- Adhered to policies and safety standards for handling human tissue.
- Achieved an 85% approval rate for completed dissections, surpassing expectations.
- Attended all required trainings to enhance skills and competencies.
Revenue Cycle Specialist/Insurance Verification/Eligibility Specialist
UNIVERSITY OF HOUSTON FAMILY CARE CENTER
HOUSTON, TX
01.2024 - 01.2025
- Streamlined patient financial services operations, enhancing eligibility determination and claims processing.
- Reduced claim denials by verifying accurate coding and billing information.
- Assessed sliding fee scale eligibility using multiple database systems to coordinate care services.
- Resolved billing inquiries and established payment plans, fostering positive patient relationships.
- Determined eligibility for Medicaid, Healthcare Marketplace, SNAP, and TANF programs efficiently.
- Collaborated with medical staff to ensure thorough documentation for insurance verification.
Senior Appeals & Grievances Coordinator
OPTUM INC/UNITED HEALTH GROUP
Houston, TX
03.2025 - 09.2025
- Managed complex Medicare Advantage appeals workflow, including coverage determinations and payment disputes.
- Ensured 100% compliance with timeframes and regulatory standards for grievance resolution.
- Coordinated with clinical teams, legal departments, and external providers to resolve intricate cases.
- Reviewed medical records and clinical documentation to support appeal determinations.
- Maintained extensive knowledge of CMS regulations and Medicare Advantage requirements.
Education
Some College (No Degree) - Business Administration
California State University, Northridge
Northridge, CASkills
- Healthcare appeals and grievances management
- Regulatory compliance and policy interpretation
- Medical documentation review
- Revenue cycle management
- Customer service and conflict resolution
- Claims processing and denial resolution
- Healthcare program administration
- Data analysis and quality assurance
Certification
- Certificate in Medical Terminology, Moorpark College, 2010
- Certified Application Assistance Navigator (Medicaid)
- Certified Application Assistance Navigator (Health Insurance Marketplace)
Medical Coding And Classification Systems
- ICD-10 CODES - Diagnostic coding for medical necessity determinations and appeals
- CPT/HCPCS CODES - Procedural coding for coverage decisions and reimbursement analysis
Revenue Cycle And Practice Management Systems
- Resolute - Hospital revenue cycle management and billing operations
- IDX - Healthcare information management and patient registration
- Phreesia - Patient intake automation and insurance verification
- Emasis - Healthcare management system operations
- Innovare - Specialized healthcare workflow management
Electronic Health Record Systems
- Epic - Epic EHR - Comprehensive Patient Data & Clinical Documentation
- Centricity - Patient management and clinical workflow integration
- AthenaOne - Cloud-based practice management and revenue cycle operations
Websites
References
References available upon request.
Timeline
Senior Appeals & Grievances Coordinator
OPTUM INC/UNITED HEALTH GROUP
03.2025 - 09.2025
Revenue Cycle Specialist/Insurance Verification/Eligibility Specialist
UNIVERSITY OF HOUSTON FAMILY CARE CENTER
01.2024 - 01.2025
Dissector
ARTIVION
03.2022 - 11.2023
Family Caregiver
Georgia Career Break
01.2020 - 02.2022
Appeals and Grievances Coordinator
CENTENE CORPORATION
01.2017 - 01.2020
Some College (No Degree) - Business Administration
California State University, Northridge