Summary
Overview
Work History
Education
Skills
Work Availability
Quote
Timeline
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Rowena Annette Joyner

Atlanta,GA

Summary

Medical Claims Professional, Analyst, Auditor, Manager “Enhancing Efficiency and Productivity” Highly motivated professional in medical administration with extensive experience in insurance processing, employee benefits and other HR practices. Recognized for solid supervisory, interpersonal, and team building skills. Strong in organizational leadership and problem solving. Extensive experience with medical and general office software. CORE STRENGTHS Multiple project management Support and customer service administration Accounts receivables Database maintenance Flexible and adaptable to changing environments Excellent communication skills Dedicated to improving office efficiency

Overview

27
27
years of professional experience

Work History

Under Payment Analyst

  • Established training processes and workflows
  • Increased collections with guarantors, insurance companies, and third parties on unpaid professional claims
  • Takes appropriate action to resolve all insurance, bad debt, and or self-pay unpaid balances
  • Performs insurance follow-up as necessary
  • Sends out collection letters and demand letters as appropriate
  • Documents communication thoroughly in host system
  • Contacts customer service and patients to update information
  • Performed production and contact quotas
  • Parallon quotes benefits contacts with payers and insured on benefits Insurance Products Skills: Epic, Cactus, GAMMIS, Medassets, MS-Excel, Medicaid, CMO Medicaid, Commercial Insurance CMO’s and Medicare, CMS, MS Office, MS Communicator, MS Outlook/Exchange and IE, Internal systems that include but is not limited to MS programs, Excel sheets, phone training/ customer service, call center
  • Multiple applications experience
  • Strong communications experience
  • Diagnostics.

Underpayment Analyst

Parallon
01.2016 - Current

Data Integrity Specialist

PEACH STATE HEALTH PLAN
01.2012 - 01.2016
  • Analyze and determine provider code sets
  • Modify provider data as needed to support claims payment, member assignment, and state and internal reporting needs
  • Work reconciliation projects and complex analytical tasks for Provider data projects
  • Coordinate provider data between the health plan database (Amysis) and Delegate system (external provider database)
  • Prepare validated provider credentialing and contracting data and reports
  • Lead problem solving and coordination between the health plan and external agencies’ staff to correct data discrepancies
  • Create and generate reports through MS-Excel, MS-Access, Business Objects, Cactus, Portico and Emptoris
  • Act as Liaison with corporate staff for programming/development needs related to reporting
  • Manage work load for coordinators and serve as a Team Lead when department manager is out or unavailable
  • Audit of business operations Insurance Products Skills: Amysis, Cactus, Portico, Emptoris, MS-Excel, Medicaid and Medicare, Commercial insurance
  • Market Place affordable care plans.

Billing Specialist Consultant

PROACTIVE MEDICAL DIAGNOSTICS
01.2010 - 01.2011
  • Conducted claims management, accounts receivable, verification, invoicing, collections, and denial resolutions for a major medical practice
  • Implemented and coordinated re-billing, appeals and adjustments of client accounts
  • Trained staff on payment processing of high dollar claims ($10k-$1M+)
  • Developed standard operating procedures for appeals and insurance payments
  • Trained billing department and service providers on proper reporting and coding procedures
  • Created a diary tracking system to follow up on denials
  • Implemented proper verification of benefits to ensure correct payment processing
  • Insurance Product Skills: Medicare, Medicaid, Employee Benefits, Group Medical, Workers Compensation, HMO, PPO, COB, Dental, Managed Care, Mental and Nervous

FMLA Leave Specialist

SEDGWICK CLAIMS MANAGEMENT SERVICES
01.2008 - 01.2010
  • Implemented application and processing of FMLA benefits to major medical Laboratory Corporation
  • Reviewed medical certifications and approved Federal leaves
  • Processed and determined qualification of applicants of leave
  • Tracked time and provided written correspondence to human resource departments and applicants
  • Provided logistical support for human resource departments and claimants
  • Administrated
  • FMLA Benefits for major medical lab corporation
  • Maintained accurate and current knowledge of federal mandates
  • Tracked leave time per Federal guild lines
  • Insurance Product Skills: FMLA guidelines

Claims Analyst Consultant

JACOBSON SOLUTIONS
01.2003 - 01.2008
  • Specialized in the auditing, analysis, and recovery of claims
  • Provided industry expertise to various companies requiring backlog reduction, auditing, and overpayment recovery
  • Supervised a team of analysts, quality control auditors as well as recovery experts
  • Reduced backlog in the tens of thousands resulting in penalty elimination
  • Achieved company record in claims payments and the effective analysis and audit of claims for accuracy and payment recovery
  • Slashed expenses by increasing employee efficiency, eliminating costly training, and monitoring the progress of new hires
  • Major Clients included: Blue Cross/Blue Shield, Medicare/Medicaid, UHC, Cigna, Aetna, Humana, WC, MHN, Anthem, Amerigroup

Senior Claims Analyst

BENESIGHT TPA, ATLANTA
01.1997 - 01.2003
  • Developed and maintained third-party administration accounts for clients of entertainment firm
  • Account manager, responsible for processing all medical claims for company employees
  • Secured and processed reinsurance coverage
  • Negotiated lease agreements with medical software companies as required.

Education

Associate of Science -

Borough of Manhattan Community College of The City University of New York
New York, NY

Skills

  • SYSTEM SKILLS
  • Microsoft Office Suite, NASCO, ACCLAIM, AMYSIS, CICS, BLUE CARD, FACETS, ERISCO, PRUTRAC, RIMS, MACESS, EPIC, ALL INSURANCE PAYOR PORTALS

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote

The way to get started is to quit talking and begin doing.
Walt Disney

Timeline

Underpayment Analyst

Parallon
01.2016 - Current

Data Integrity Specialist

PEACH STATE HEALTH PLAN
01.2012 - 01.2016

Billing Specialist Consultant

PROACTIVE MEDICAL DIAGNOSTICS
01.2010 - 01.2011

FMLA Leave Specialist

SEDGWICK CLAIMS MANAGEMENT SERVICES
01.2008 - 01.2010

Claims Analyst Consultant

JACOBSON SOLUTIONS
01.2003 - 01.2008

Senior Claims Analyst

BENESIGHT TPA, ATLANTA
01.1997 - 01.2003

Under Payment Analyst

Associate of Science -

Borough of Manhattan Community College of The City University of New York

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Rowena Annette Joyner