Jennifer Matukaitis
Shavertown,PA
Summary
Experienced with credentialing processes and regulatory compliance. Utilizes effective communication and meticulous documentation to manage credentialing for healthcare providers. Knowledge of industry standards and best practices ensures thorough and efficient credentialing operations.
Overview
10
10
years of professional experience
Work History
Business Analyst
Centene
04.2023 - Current
- Reviewed and verified primary source documentation to maintain accuracy in practitioner credentials.
- Managed provider enrollment processes, ensuring compliance with state and federal regulations.
- Partnering with Contracting to ensure accurate loading of provider contracts and fee schedules
- Processed 60+ initial applications per month, completing verifications within 15 days on average
- Constructed reports with SQL queries for tracking alignment with key performance indicators.
- Conducted preliminary assessment of new providers to ascertain eligibility for network enrollment.
- Executed daily responsibilities with precision and efficiency.
Claims Processor
Loomis
05.2021 - 12.2023
- Managed high volume of incoming claims in alignment with established policies and procedures.
- Conformed to all applicable laws, regulations, and company standards throughout claims management.
- Leveraged understanding of coding systems like CPT-4 and HCPCS codes to facilitate proper reimbursement
- Optimized workload to consistently exceed productivity and quality standards.
Claims Supervisor
Broad-Path
11.2015 - 05.2020
- Built talented teams of 30 claims administrators dedicated to timely and compliant resolutions.
- Educated new staff on medical claim processing systems, policies, and procedures.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Administered quality assurance assessments on submitted claims to confirm completeness and accuracy ahead of submission.
- Assembled reports for management outlining status of current claims and pinpointing trends in billing practices.
- Analyzed performance metrics such as denial rates, payment accuracy levels, and turn-around times, benchmarking results against established goals.
- Managed and reviewed daily activities of medical claims department staff to secure precise and prompt handling of all claims.
Skills
- Expertise in HIPAA standards
- Provider credentialing
- Data analysis proficiency
- Analytical report development
- Knowledge of insurance protocols
- Credentials validation process
- Expertise in credentialing documentation
- Experienced with Microsoft Office applications
Timeline
Business Analyst
Centene
04.2023 - Current
Claims Processor
Loomis
05.2021 - 12.2023
Claims Supervisor
Broad-Path
11.2015 - 05.2020
Similar Profiles
DIANA GUTIERREZ, MSN, RN.DIANA GUTIERREZ, MSN, RN.
Triage Nurse- PRN at CenteneTriage Nurse- PRN at Centene
Hallie PikeHallie Pike
Member and Provider Customer Service Rep I at CenteneMember and Provider Customer Service Rep I at Centene
Jennie ZautnerJennie Zautner
Business Analyst at CenteneBusiness Analyst at Centene
Jodi BendickJodi Bendick
CRS/CPS/Crisis Worker at Northeast Counseling ServicesCRS/CPS/Crisis Worker at Northeast Counseling Services
Robert PavlickRobert Pavlick
Rental Manager at Five Star Equipment, IncRental Manager at Five Star Equipment, Inc