Janice Cesino Email & Phone Number

Hartford, Connecticut Area

Performing root cause analysis and software testing of identified system issues related to healthcare claims rejections and denials. Collaborate with business systems analysts, configuration specialists and developers to promote system enhancements to improve claims processing efficiency by reducing inbound rejections and claims processing denials. Subject matter expert for national claims center processing platform.

Hartford, Connecticut Area

Oversight of entire claims production department including inventory and staff management. Support new business implementations and system enhancement/break fix production impact analysis. Manage rework and claim adjustment projects.

Managed the project implementation of CMS Medicare policy announcements including the complete policy review and documenting business requirements. Management of work plan deliverables, meeting scheduled target dates. Collaborated with development, testing, and operations teams for change control work effort estimates and demand management implementation

Management of three production departments continuously insuring service levels are met. Responsible for claims adjudication, accounts receivable, budget forecasting, hiring, performance evaluations and client audits. Managed a staff of 25 individuals dedicated to timely processing of health insurance claims and prior authorizations. Significantly reduced inventory backlog by cross training departmental resources. Established and monitored performance metrics for claims, adjustments, mail handling and scanning processes. Reported the achievement of 26 specific departmental service level metric successes for quarterly and annual reporting. Consistently met or exceeded all SLAs. Analyzed application changes and developed new processes needed. Projected staffing needs based on analysis of historical data. Determined root cause analysis of errors or issues in need of improvement. Management of Document Control mailroom activities, including receiving, sorting, and scanning and archiving of incoming claims. Oversight of all document control tasks including permit and bulk mail accounts, courier duties and provider bulletin distribution. Management of Third Party Liability and Financial teams including third party billing and collection, cost avoidance and recovery, and other financial activities including accounts receivable and bank account reconciliation. Implemented process controls to improve security. Performed monthly budget forecasting, monthly SOX compliance activities and annual compensation planning.

Responsible for insuring customer service and ATM transaction monitoring excellence of 120 representatives in a fast paced customer service call center environment, insuring service levels are achieved or surpassed. Created training program, training documentation and CSR call monitoring plan. Reduced average wait time and abandon rate by developing online tools to assist CSRs with problem resolution. Hands on disaster recovery planning and implementation. Measurement of performance relating to service levels including customer issue tracking using the Vantive tool.

Associate Of Science (A.S.), Liberal Arts And Sciences, General Studies And Humanities, 3.9

Activities and Societies: Deans List-Honors Spring and Fall 2015 Phi Theta Kappa Honor Society

Cpc, Certified Professional Coder

Activities and Societies: AAPC MAGNA CUM LAUDE CPC CERTIFICATION Mastery of ICD-9-CM; CPT; Medical Terminology; Health Insurance; MediSoft.

Liberal Arts And Sciences

Education record