Jahnell Hines
Whitehall
Summary
Professional in insurance sector with robust background in claims analysis. Known for meticulous approach to examining claims and supporting team objectives through effective collaboration. Reliable and adaptable, consistently contributing to process improvements and accurate claims resolutions. Proficient in problem-solving and critical thinking.
Overview
20
20
years of professional experience
Work History
Claims Scrubber Analyst
St. Lukes University Health Network
12.2023 - Current
- Maintain current knowledge of coding, compliance, and documentation guidelines
- Resolve coding denials through claim correction or appeal. Claim corrections will be made after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator. Demonstrate the ability to formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and published Academy or Societal guidance
- Provide coding guidance to providers and charge entry staff for single or low volume errors. Report high volume coding denial trends to the coordinator
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintains knowledge of current trends and developments in the medical practice services reporting, billing and collections.
Accounts Receivable Specialist
St. Luke's University Health Network
07.2016 - 12.2023
- Process all UB04 and HCFA-1500 claims through the related billing system, working the related claims scrubber in a timely and efficient manner; performs all associated duties in order to ensure the completeness and accuracy of all claim information, facilitating maximum reimbursement.
- Performs duties as scheduled, prioritizing as required to ensure claims are submitted timely, and maximize cash flow is received.
- Verifies accuracy of billing data and makes revisions as need be.
- Identifies and reports any claim submission issue trends to Management team.
- Obtains and maintains a basic understanding of third party billing requirements as assigned, including federal, state and commercial payers.
- Responsible for account receivable, investigates and reviews claims based on the productivity standards set by management.
Nutrition Service/ Dietary Call Service Aide
St. Luke's University Health Network
10.2005 - 07.2016
Education
Specialized Diploma - Medical Coding and Billing
Northampton Community College
Bethlehem, PA05.2015
CPC Certification - Health Information Management
AAPC
02-2025
Skills
- Time management
- Communication skills
- Computer literacy
- Reliability
- MS Excel
- Documentation and reporting
Timeline
Claims Scrubber Analyst
St. Lukes University Health Network
12.2023 - Current
Accounts Receivable Specialist
St. Luke's University Health Network
07.2016 - 12.2023
Nutrition Service/ Dietary Call Service Aide
St. Luke's University Health Network
10.2005 - 07.2016
Specialized Diploma - Medical Coding and Billing
Northampton Community College
CPC Certification - Health Information Management
AAPC
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