Shaquavia Jones
Summary
Experienced in payment adjustments, customer service, and accounts receivable management with strong administrative and problem-solving skills.
Overview
13
13
years of professional experience
Work History
Patient Service Representative
Summit Health
05.2024 - 12.2024
- Scheduled patients in Medical Manager System.
- Analyzed medical records to satisfy insurance company mandates. Planning and managing clients digital strategies, approving web presence to achieve their digital marketing goals.
- Applied charges and updated patient records.
- Gathered information from multiple sources to simplify billing and organize accounts.
- Researched, processed, and responded to service requests through all inbound calls and digital channels.
- Provided ongoing support to users, including answering questions and troubleshooting any issues they may have.
Payment Record Adjuster
WPS Health Solutions
09.2017 - 04.2024
- Processed adjustments according to TRICARE Policy by making an additional payment, reissue, or statistical adjustment.
- Identified and credit refunds to correct claim history.
- Contacted beneficiaries, providers, and other agencies as necessary to obtain information to ensure refunds are posted to correct account.
- Requested recoupment of payments in accordance with TRICARE Policy and Operational Manual.
- Responded to correspondence from internal and external customers to include departments within MVH Division, attorneys, insurance companies, TRICARE Management Activity (TMA), government agencies, and prime contractors.
- Coordinated benefits with commercial insurance, Medicare, and other plans Review computer generated and inventory reports to prioritize workflow to ensure claims processing timeline standards are met.
- Processed adjustments and credits with an understanding of TRICARE Encounter Data editing requirements imposed by TMA.
- Reviewed claims to determine if processing is correct according to automated claims processing system's methodology for pricing, reimbursement, and cost-sharing.
- Interpreted legal documents for payments involving judgments such as custodial or bankruptcy.
- Completed Sponsor Patient Information Updates (SPIU) accordingly.
Accounts Receivable Representative
Portfolio Recovery Associates
11.2014 - 08.2017
- Researched accounts and completed due diligence to resolve collection problems.
- Delivered exceptional customer service on all calls while maintaining calm and professional demeanor in challenging circumstances.
- Researched, analyzed and settled disputes per week.
- Monitored accounts for compliance with established payment plans and flagged those in violation.
- Used probing techniques to determine debtors' reasons for delinquency Processed payments and contracts on accounts.
Accounts Receivable Representative
NCO Financial
01.2012 - 07.2014
- Streamlined billing processes for improved efficiency and reduced errors.
- Assisted with month-end close procedures, enabling timely financial reporting.
- Managed payment plans for clients experiencing financial difficulties, maintaining good customer relations while minimizing losses.
- Reduced outstanding receivables by diligently following up on overdue payments.
- Achieved a high level of customer satisfaction through proactive issue resolution, preventing late payments due to disputes.
- Facilitated smooth audits through meticulous record-keeping and prompt provision of requested documentation.
Education
Liberal Arts
Touro College
New York, NYHigh School Diploma -
School For Legal Studies
Brooklyn, NY02.2010
Skills
- Critical Thinking
- Organization
- MS Office
- Data Entry
- Team Collaboration
- Administrative
- Customer Service
- Incomplete Payment Identification
- Accurate Payment Posting
- Aging Reports Analysis
- Insurance Verification
- Appointment Scheduling
Timeline
Patient Service Representative
Summit Health
05.2024 - 12.2024
Payment Record Adjuster
WPS Health Solutions
09.2017 - 04.2024
Accounts Receivable Representative
Portfolio Recovery Associates
11.2014 - 08.2017
Accounts Receivable Representative
NCO Financial
01.2012 - 07.2014
Liberal Arts
Touro College
High School Diploma -
School For Legal Studies
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