PEGGY JACKSON

Summary

Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to help drive team success and contribute to organizational growth.

Overview

years of professional experience

Work History

Medical Claims Analyst 1 / Provider Enrollment Reviewer

Empower AI Inc

Richmond, VA

10.2016 - 07.2025

Sorted and notated medical record layouts, formats and abstraction for a variety of medical settings.
Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy.
Reviewed and completed the required number of claims in accordance with established production standards for the project.
Participated in QA and IRR monitoring as requested.
Complied with departmental policies and procedures.
Communicated internally with all levels of CERT.
Complied with Program Integrity Manual (PIM) and Statement of Work (SOW) guidelines and CMS directives and regulations pertaining to integrity, fraud, overpayments, and the handling and disclosure of information.
Supported continuous improvement initiatives by actively participating in team meetings, trainings, and workshops focused on enhancing reviewer skills and processes.
Performed other projects or duties as assigned by the Medical Records Manager.
Crossed-Trained in Customer Service Department to help team when needed.
Trained 4 new hires for Provider Enrollment Review and continued to mentor when needed.
Researched and resolved complex medical claims issues to support timely processing.
Generated, posted and attached information to claim files.

Patient Access Representative (Temp)

Randstad Professionals Staffing

Richmond, VA

03.2016 - 09.2016

Processed orders received from referring physicians.
Gathered important information in making appropriate decisions as to where and when to schedule appointments.
Provided excellent customer service through active listening skills, understanding patient needs, and offering tailored solutions where applicable.
Maintained accurate patient data within electronic health record (EHR) systems to ensure compliance.
Ensured compliance with HIPAA regulations to maintain confidentiality of sensitive patient information during all interactions.

ROI Information Specialist (temp)

JAS Staffing

04.2013 - 08.2015

Maintained confidentiality and security with all privileged information.
Received and processed requests for patient information in accordance with Company and Facility policies and procedures.
Ensured medical records were assembled in standard order and were accurate and complete.
Assisted with some patient walk-ins.
Responsible for safeguarding patient records and ensuring compliance with HIPAA standards.
Used database to research, gather, analyze and present data.

Education

Applied Technology / Certification

John Tyler Community College

12-2007

Skills

Claims processing proficiency
HIPAA compliance
Electronic claims processing
Problem-solving abilities

Time management abilities
Team collaboration
EHR systems used Epic, Cerner, Meditech, CERT, Mckesson, HPF

Timeline