Esperanza Jordan
Chester
Summary
Skilled in trend analysis and discrepancy resolution, ensuring accurate billing and compliance with regulatory standards. Proven ability to enhance processes through collaboration with management and effective data utilization.
Overview
7
7
years of professional experience
Work History
Recovery Analysis II
Conduent Credit Balance Solutions, LLC
08.2022 - 02.2026
- Identified overpayments across Aetna, Anthem, Cigna, Humana, Kaiser, Sentara, and Molina, contributing to enhanced financial accuracy.
- Reviewed, medical records, eob's against charges billed.
- Adjusted off contractual adjustment, causing credits.
- Educated management teams on overpayment trends by payor.
- Notified hospital and physician management of identified overpayments and initiated recoupment processes.
- Conducted audits on three hospitals and one physician practice to review billing accuracy.
- Reviewed reimbursement rates per payor contracts, ensuring alignment with liability rates to mitigate financial discrepancies.
- Managed monthly meetings to discuss recoupment statistics and improvements.
- Analyzed client credit balances for precise account management and reporting.
- Collaborated with management to enhance process efficiency and resolve account discrepancies.
Patient Accounts Analyst II
Richmond Ambulance Authority
Richmond
08.2021 - 08.2022
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Reviewed clinical data from medical records to accurately assign CPT and ICD 10 codes, and modifiers to ensure compliance with billing.
- Followed up on unpaid claims, underpayments, overpayments, initiated reconsideration, and/ or appeal processes.
- Set up patient payment arrangements on patient responsibility balance.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Collaborated with EMT providers to clarify documentation for coding accuracy, if needed.
- Conducted audits of coded data to identify discrepancies, recommending corrections to maintain accuracy and compliance.
Sr. Claims Analyst/Provider Relations Specialist
Incept Data Solutions, Inc.
Sterling
06.2019 - 03.2021
- Ensured all entities remained adherent within Center for Medicare Services guidelines, which entailed reviewing and investigating Medical Licenses, National Provider Identifier, Office of Inspector General, and System for Award Management (SAM.gov).
- Audited paid Medicare claims from billing providers, skilled nursing facilities, pharmacy, durable medical equipment, and hospitals to ensure compliance and accuracy.
- Reviewed medical records to confirm correct HCPCS coding aligned with diagnosis codes and secured signatures for billing accuracy.
- Reported discrepancies in non-compliant medical records, state medical licenses, OIG, SAM, or NPI to CMS management for resolution.
Education
CPC
St. John University
Queens, NY01-2013
Skills
- Healthcare software systems
- Epic modules
- Spreadsheet SQL
- Medical coding accuracy
- Claims analysis
- Reimbursement trend analysis
- Audit processes
- Data reconciliation
- Compliance verification
- Financial trend analysis
- Analytical problem solving
- Critical thinking skills
- Effective time management
- Team collaboration
- Attention to detail
- Strong communication skills
Timeline
Recovery Analysis II
Conduent Credit Balance Solutions, LLC
08.2022 - 02.2026
Patient Accounts Analyst II
Richmond Ambulance Authority
08.2021 - 08.2022
Sr. Claims Analyst/Provider Relations Specialist
Incept Data Solutions, Inc.
06.2019 - 03.2021
CPC
St. John University