Deborah Jimenez Email & Phone Number

Deborah Jimenez is a Guideline Goverance Lead at Carelon Medical Benefits Management at Carelon. She possess expertise in claim, microsoft word, employee benefits, customer service, appeals and 9 more skills. She is proficient in English. Colleagues describe her as "In my role as a Network Specialist, we would frequently hear from Providers regarding claims that denied for Timely Filing, Invalid Diagnosis, Invalid CPT or modifier, and needed assistance in order to get the claim back into our system. Working with Deborah was very easy, efficient, quick, and meticulously documented. Whether the claim required an escalated clinical review, member feedback and documentation, or in worst case scenarios--an escalation to our Disciplinary Review Board, Deborah made certain each step was clearly defined with realistic timeframes. If there was unpleasant news that needed to be relayed back to Providers, Deborah was always willing to issue a letter, a personal email, or sit in on a call. It gave me a sense of comfort knowing that Deborah was managing these important decisions that impacted our Member and Provider quality and safety. Deborah was not only well-versed in Appeals and Grievances, and other Quality related measures, but also a subject matter expert on compliance, claims requirements, and HEDIS reporting. Deborah's data research skills were instrumental in helping the organization become URAC (Utilization Review Accreditation Commission) Certified in 2017. Prior to her role in Appeals and Grievances, she worked in the Customer Service department as a Team Leader & Trainer, and was a wealth of information about all aspects of the company. In the rare moments when Deborah wasn't deep in reporting, she was a bright light who was always there with a friendly, funny, or warm comment to break the stress of the job. She also organized and participated in team activities both in and out of the office. She is undoubtedly one of the reasons I was so succesful in my time at ComPsych, and one of the reasons I enjoyed my work days. Thanks, Deb!"

Listed skills include Claim, Microsoft Word, Employee Benefits, Customer Service, and 10 others.