Summary
Overview
Work History
Education
Skills
Affiliations
Hobbies and Interests
Certification
Timeline
Generic

Leah Jackson

Harrisburg

Summary

Analytical Health Claims Supervisor with a Bachelor’s degree in Information Technology/certificate in Health Information Technology, is motivated to join an integrity-driven organization, to showcase my talents in a Lead position. Over twenty years dedicated to the analysis of health claims data in the Healthcare Delivery System. Twenty years in a medical/insurance environment; well versed in the physician/professional billing revenue cycle; recognized for cost-savings procedural updates from the collection of specified statistical data.

Overview

28
28
years of professional experience
1
1
Certification

Work History

Health Claims Supervisor

CAPITAL BLUECROSS
09.2000 - Current
  • Supervisor of 32 Claims' Examiners
  • Create Job Requisitions
  • Interview and hire qualified personnel
  • Process improvement consultant
  • Lead in Procedure Development
  • Develop and distribute informational bulletins, manual updates for up- to- date protocols
  • Coordinate daily work distribution
  • Improve and develop strategies to maintain procedural accuracy, quality and productivity
  • Focused communication with Operational Supports to troubleshoot systems’ issues relating to medical/hospital claims processes
  • Maintain, edit and update Operating Procedures and Training Materials for Business Analysts, Trainers, Auditors and Staff
  • Review and respond to technical questions from claims’ examiners
  • Perform independent research for correct application of member benefits
  • Identify and participate in resolution of claims’ processing problems
  • Support Management by assuming leadership roles
  • Assist personnel in meeting departmental goals of timely and accurate claims/inquiries processing
  • Provide on the job training
  • Research and process claims for Managed Care, Employee, ITS, FEP
  • Research and verify various on-line files and external applications to ensure accurate processing for Claims' payment

Congressional Liaison

HIGHMARK BLUECROSS BLUESHIELD
08.1997 - 08.2000
  • Frequent phone contact with Medicare Regional offices and Congressional Representatives on behalf of Constituents
  • Examined unpaid and rejected claims to determine reasons for rejection and non-payment
  • Provided dedicated customer care to Medicare beneficiaries for claims processing explanations
  • Supreme customer service, verbal and written, to internal and external customers
  • Ensured all insurance companies and governmental entities were posted accurately and in a timely manner using the correct forms, policies and procedures
  • Resolutions provided judiciously and accurately for escalated claims processing matters
  • Provided explanation relating to Medicare EOMBs and DMERC

Education

Bachelors - Information Technology with Certificate in Health Information Technology

University of phoenix
10.2017

Skills

  • Communication
  • Fraud, Waste, Abuse
  • ICD 9/10
  • Staff Training
  • Physician Billing
  • COB/Tertiary
  • Medicare Primacy
  • HIPPA
  • Compliance
  • Microsoft Outlook
  • Microsoft Word
  • Microsoft Excel
  • Microsoft Powerpoint
  • Salesforce

Affiliations

The National Society of Leadership and Success (NSLS)

Hobbies and Interests

  • Writing
  • Learning a language
  • Travel
  • Roller Skating
  • Drawing

Certification

HIT

Timeline

Health Claims Supervisor

CAPITAL BLUECROSS
09.2000 - Current

Congressional Liaison

HIGHMARK BLUECROSS BLUESHIELD
08.1997 - 08.2000

Bachelors - Information Technology with Certificate in Health Information Technology

University of phoenix

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Leah Jackson