Jadelyn Fields Email & Phone Number

• Recruit future talent and internships. Train, develop and supervise employee management. Coach, direct and develop a team of all-star Provider Performance Representatives, including hiring, onboarding, training and professional development for the overall success of the network operations department.• Participates and orchestrates development and implementation of systems that support network operations and network management.• Communicates and advocate providers' needs to internal stakeholders to drive creation of solutions that meet our mutual business goals.• Collaborates with relevant internal stakeholders to identify obstacles and barriers that impact providers globally and execute methods to mitigate risk and provide effective resolutions. • Consistently strives to foster trust and cooperation to strengthen partnerships and uphold our commitments, ensuring the integrity of the organizations mission and vision is paramount. • Analyze data (claim, prior authorization, portal) and review with appropriate departments to ensure accuracy and address concerns. Facilitates claims-based change management performance, anticipating and creating actionable plans that drive network performance at the client level supporting internal goals and regulatory compliance.• Handles complex and/or difficult provider inquires and/or challenges, conducts root-cause analysis and provides resolution. • Product owner - oversees, creates and publishes provider content on public websites and secure provider portal.• Develops and executes on-going training and education of industry, company, and regulatory policy requirements to internal staff and providers through various means (e.g., provider notices, forums, manuals, websites, toolkits, videos, on-site meetings, teleconference)• Monitor and assist providers in following all policies and procedures; ensure adherence to relevant federal and state laws, contract standards, and Health Choice’s ethical standards.

• Subject matter expert in revenue cycle management, coding, billing, clams processing, disputes/grievance, prior authorization, and network service systems. Facilitates the exchange of information between these systems and providers.• Serves as chair member for Provider Relations Improvement. Presents and gathers trends of information, feedback and analysis from various departments to identify opportunities to educate providers and improve provider satisfaction. • Primary role is to educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions, electronic fund transfers, and other available Health Choice Arizona and AHCCCS resources. • Overall goal is to improve the provider experience and, ultimately, the member experience.

Phoenix, Az

Subject matter expert responsible for talent selection, training, mentoring and employee development while responding to complex issues and proficiently completing health-plan and department projects as assigned. Applies National Federal, State and Managed Care Cost Containment policies in claim adjudication and reimbursement processing. Identifies, tracks trends and resolves benefit, contract, coverage, eligibility, technical, data, billing errors and payment discrepancies. Creates and develops end user written procedures and policy documents for department adherence, eliminating and reducing production waste. Exceeds quality and production standards as set forth by department and the State of Arizona (AHCCCS).

Oversees the daily operations serving multiple Physician Medical Clinics and Hospital Physician Services billing. Responsible for the implementation of current and future strategies to bill insurance, process payments, minimize bad debt, improve cash flow, and manage the company’s insurance and receivables. Responsible for managing day to day activities of the billing department, making recommendations for policy and procedure enhancements to improve financial performance and insuring consistency in the application and enforcement of credit and collection policies to minimize revenue adjustments. This position works with outpatient clinic operations leadership on revenue cycle performance to meet short term strategic goals and will provide analytical analysis, create written guidelines, policies and procedures in accordance with implementation of all work processes as a result of thorough analysis. Ensures compliance with company policies, manage employees and achieve operational goals and objectives.4D Medical focuses on increasing revenue for our clients by finding denials trends within the practice, proactively calling on aged claims, providing advice to physicians and practice managers on how they can perfect their practice and increase their revenue. 4D Medical provides each client with a dedicated Account Manager that manages their account, answers questions and is always available to them. We currently bill for the following specialties: Physician Hospital Billing Cardiology Dermatology Endocrinology ENT Gastroenterology Hematology Infectious Disease Internal Medicine Nephrology Neurology OB/Gynecology Oncology Ophthalmology Orthopedics Pathology Pediatrics Physiatry Podiatry Psychiatry Pulmonary Radiology Rheumatology Surgery Urology

Licensed Insurance Producer liaison between clients, health insurance providers and the Healthcare Marketplace uncovering solutions in a complex health insurance environment. Counsels clients of the unique individual impacts of the Affordable Healthcare Act, their healthcare benefits and penalties and outline available healthcare benefit plan options, and facilitate plan selection and enrollment.

Establishes client on-boarding process; credentialing, software installation, practice management set-up, training, technical and all functional support for new and existing clients. Assists in monitoring and actively working billing and collection activities. Assures proper accounting procedures and controls are in place and followed. Ensures payments for billings are posted accurately and on a timely basis. Prepares daily deposits. Maintains accurate records to ensure an accurate and timely closing for month-end procedures for each client assigned on the SilverTree platform. Assists in the supervision of the Business Office staff and others for whom they are administratively or professionally responsible.

Assigned to specialty collection projects such as stop-loss, and potentially uncollectable account reviews. Versatile in project scope with all actions of billing and collecting, having a broad knowledge of Government and Commercial medical insurance payers with a high level of skill set in provider credentialing, contracting and reporting. Takes ownership of project tasks assigned as the project scope at hand. Analyzed and created Standard Business Billing Process for all secondary claims and processing Medical Records request to ensure completion on a daily basis.

Project Manager/Business ConsultantI served as the lead liaison between the contracted vendor MedReview and AmeriChoice to coordinate and complete implementation of vendor practices for several divisions. Assesses and interprets customer needs and requirements. Facilitates day to day client planning processes ensuring business needs are met. Coordinate and identify solutions to address issues as they occur. Provide explanation and information to all stakeholders on complex issues.Quality Validator/Auditor I ensured all overpayments identified and put into recovery process met the quality requirements as outlined by CCM and client APIPA. While assigned in this capacity I facilitated an end-to-end business process that put the required batches through for Healthplan approval to secure recovery. This resulted in the reduction of the overall volume of inaccurately identified overpayments.Provider Service ManagerAs a Provider Services Manager, I served as the key contact for physicians, clinics/facilities and regulators in the resolution of recovery-based service issues. Primary responsibilities include the timely resolution of service based issues related to the recovery process. Because of the sensitivity of this work it is not uncommon for the Department of Insurance or the office of the State Attorney General to become involved in the process. Extensive, timely, accurate research and analysis with clear and concise outcomes are the requirements for successful communication with these agencies and all other stakeholders.

Responsible for all collection and clerical support functions including, but not limited to, management and training of staff, documentation review and reporting, private party claim submission via paper and electronic filling for 3 office locations valley wide. Developed and implemented system improvements which supported company growth. Significantly improved cash collections and reduced the overall aged account receivables. Maintained current and relevant knowledge of the industry and kept staff abreast of changes by training them as new information became available.

Rite-Aid Specialty Pharmacy: Maintain daily workflow of (8) employees; responsible for contacting patients of the specialty pharmacy and complete with them a medication assessment based on the specialty medication the patient has been prescribed (specialty medication meaning- high costs injectables for infusions). Received inbound calls from more than 3400 stores around the USA regarding any helpdesk issues. Maintained daily report of workflow and monthly report of Quality Management scores for the team. Worked closely with management to provide any assistance needed to any other employee as well as with Client Services and Senior Management with regards to program effectiveness. Continued education via DDI on-line courses: completed various courses specific to supervisory and/or management training.

Registration Representative Lead – Scottsdale Healthcare: South & North Campus’ Breast Health Facility: Responsible for maintaining flow of front office procedures; patient registration into computer database, obtain any prior authorization or insurance verification required by medical insurance for scheduled procedure(s), scheduled and verified future patient procedures. Assist patient with preparing for procedure in dressing room and helping them to be as comfortable as possible throughout their visit with us. Worked tightly with back office staff (Technicians and Radiologists) to run a well-organized facility.Registration & Admitting: Interviewed and retrieved accurate patient demographic and financial information for proper billing, admit patient accounts (i.e. Outpatient, Inpatient, Observation, OB or Emergency visits) into clinical database for hospital records. Communicated with health insurance companies via telephone, e-mail and fax to obtain pre-authorization (when applicable) or verification of insurance benefits and eligibility of medical treatment; compiled medical charts for documentation. Worked with the Department of Economic Security through the AHCCCS program. Receivables and collection of co-payments for medical services; recorded and posted emergency room visit information into a ‘log’ on a daily basis for corporate documentation, controlled entire hospital bed assignment for 3rd shift; attends monthly staff and frequent educational meetings in compliance with current HIPPA and JCAHO regulations.