Tina Jaggers
Louisville
Summary
Offering a strong foundation in analytical thinking and project management, I am eager to learn and grow in a new environment. Brings the ability to quickly understand complex concepts and apply data-driven solutions. Ready to use and develop critical thinking and organizational skills in a medical claims/contracting role. Highly skilled Senior Specialist with significant experience in project management, data analysis and strategic planning. Strengths include strong leadership skills, problem-solving abilities and effective communication. Previous work has led to increased efficiency in operations, streamlined processes and improved team performance.
Overview
10
10
years of professional experience
Work History
SR SPECIALIST, CONTRACTING/CREDENTIALING/PROVIDER ENROLLMENT
Molina Healthcare/Passport
01.2022 - Current
- Work closely with contracting for provider loads
- Contract loads- verify rates and contracting language
- Responsible for Q&A for teams credentialing work
- Completed Credentialing and Enrollment applications within guidelines and Kentucky State deadlines
- Help coordinate training manuals for team and assist with trainings and daily questions
PROVIDER RELATIONS COORDINATOR/G&A/CREDENTIALING
Signature Advantage Plan
06.2021 - 01.2022
- Responsible for processing G&A
- Completed profile reviews in a timely manner
- Analyze claims according to documents revied by clients
- Trouble shooting techniques/identify credentialing issues and report back to management with a solution
- Asist with claims and authorization issues
- Complete monthly Provider Committee meetings to complete credentialing
- Assist with training
CREDENTIALING COORDINATOR
Evolent Healthcare/Passport
04.2020 - 05.2021
- Complete monthly Provider Committee meetings to complete credentialing
- Work with Key Provider Groups on enrollment issues
- Work with contracting/claims to help load contracts
- Have monthly calls with key providers to identify group issues
- Liaison for large group loads
- Create DTP
- Assist with training
PROVIDER ENROLLMENT COORDINATOR/LIAISON
Evolent Healthcare/Passport
03.2018 - 04.2020
- Responsible for front to back credentialing/re-credentialing process for new provider adds
- Completed profile reviews in a timely manner
- Assist with special projects
- Trouble shooting techniques/identify credentialing issues and report back to management with a solution
- Follow NCQA guidelines
- Create DTP
- Assist with training
INSURANCE COORDINATOR
Kindred Healthcare
03.2016 - 03.2018
- Verify Eligibility of all insurance companies including Medicare, Commercial, Workers Compensations, and Medicaid
- Work with the medical office and hospitals to make sure all financial and clinical information is correct
- Verify authorizations and Denials
- Correct and update coding errors if needed
- Work with nurses to get authorizations started
- Create Desk top procedures
- Assist with training
Education
Associates Degree - Health Information Management/Coding
Jefferson Community And Technical College
Louisville, KY01-2027
Skills
- Over 15 years of hands-on experience in claims and customer service
- Strong and professional customer service skills
- Identify underpayment/overpayments, and revenue recovery
- Able to investigate and resolve claims issues, underpayments, and overpayments
- Identify financial errors and request updates
- Handle escalations in a calm, timely manner
- Create desktop procedures
- Assist with training, liaison
- QNXT / SharePoint
- Read and assist with contract loads
- Innovation management
- Credentialing processes
- Effective communication
Timeline
SR SPECIALIST, CONTRACTING/CREDENTIALING/PROVIDER ENROLLMENT
Molina Healthcare/Passport
01.2022 - Current
PROVIDER RELATIONS COORDINATOR/G&A/CREDENTIALING
Signature Advantage Plan
06.2021 - 01.2022
CREDENTIALING COORDINATOR
Evolent Healthcare/Passport
04.2020 - 05.2021
PROVIDER ENROLLMENT COORDINATOR/LIAISON
Evolent Healthcare/Passport
03.2018 - 04.2020
INSURANCE COORDINATOR
Kindred Healthcare
03.2016 - 03.2018
Associates Degree - Health Information Management/Coding
Jefferson Community And Technical College