Jon Dessen Email & Phone Number

Baltimore, Md, Us

Catonsville, Maryland, United States

Columbia, Md

Act as risk manager for Medicare Secondary Payer Integration Contractor (MSPIC). Support CMMI level 3 appraisal as owner of risk management process area Risk Manager, facilitate regular risk management meetings, and maintain project risk management plan, risk register, and issues log.Act as project SME for System Consolidation software development project. Assisted with the development and review of business and user requirements, facilitate and document minutes of regular requirement review and user review meetings, and assist with the development and review of the system user guide.Acted as interim project manager for System Consolidation project from September 2014 to April 2015.Developed methodology and template for Return on Investment (ROI) report deliverable allocating the MSPIC’s costs 10 categories related to COB and MSP recovery activities.Part of team responsible for monitoring and responding to incoming messages to Coordination of Benefits & Recovery (COB&R) program Beneficiary Feedback Mailbox.Perform quality assurance reviews of internal project teams to ensure compliance with published SOPs and work instructions.Draft white papers as requested.

Greater Philadelphia Area

Obtain and utilize data from client commercial health insurer, employer group health plan sponsors, Centers for Medicare & Medicaid Services (CMS), and other commercial health insurers to identify members of client who are enrolled in multiple health insurance plans. Research and apply coordination of benefits (COB) rules and regulations to determine the correct order of benefits for members of client who are enrolled in multiple health insurance plans.Review claims paid by client to identify claims that are overpaid due to misapplication of COB rules and regulations.Develop and apply new concepts of recovery to maximize revenue. Develop and apply new methods of sorting and filtering claims data to identify overpaid claims more quickly and efficiently. Draft and issue refund request letters to providers.Respond to provider disputes as appropriate.Perform quality assurance reviews on claims that peers have identified as overpaid. Complete special projects as assigned, including development of new templates for refund request letters and drafting of internal guides and instructions.

Baltimore, Maryland Area

Performed in-depth research of information related to COB and Medicare Secondary Payer (MSP) as assigned.Utilized appropriate Medicare policy and regulations necessary in the development of Medicare Secondary Payer Integration Contractor (MSPIC) strategy, operation, and oversight activities.Responsible for the tracking of updates to regulations regarding COB/MSP.Reviewed, analyzed, and developed information as it relates to COB/MSP. Developed management plans, standard operating procedures, white papers, and other documents as assigned. Assisted with implementation and operation of the MSPIC.Assisted with implementation and operation of the Medicare Coordination of Benefits and Recovery (COB&R) program. Interfaced with designated CMS personnel on matters pertinent to the COB&R program.Trained on the use of the Healthcare Integrated General Ledger Accounting System (HIGLAS).Served as interim Business Analysis Manager.

King Of Prussia, Pa

Supervised and developed a team of 10 direct reports for Medicare Part A Qualified Independent Contractor (QIC).Monitored case assignment levels of team members. Coordinated team members’ workflow and adjusted assignments to maintain a balance caseload throughout each week.Acted as liaison between management and team members to efficiently communicate information such as updated company policies.Addressed concerns of team members wherever possible on a daily basis. Forwarded concerns beyond the authority of the position to higher level management where appropriate. Continued to perform duties of a Medicare Part A Appeals Consultant, described below, with a reduced caseload. Consistently exceeded targets for quality and productivity.Conducted formal training for new employees.

King Of Prussia, Pa

Medicare Part A Processed requests for reconsideration (second level appeals) for payment of medical claims under Medicare Part A.Processed requests for reconsideration (second level appeals) related to MSP recovery actions.Independently managed 80 – 100 cases at a time.Researched applicable statutes and regulations.Confirmed medical files were in proper order.Determined whether documentation was legally sufficient for payment to be made.Referred cases for medical review by clinical panel as appropriate. Proofread medical reviews to ensure that internal criteria were met.Drafted decision letters explaining coverage determinations.Ensured compliance with CMS project standards, as well as applicable federal privacy statutes and regulations.Consistently exceeded targets for quality and productivity. Medicare Part DProcessed requests for reconsideration (first level appeals) for Medicare Part D QIC. Coordinated with beneficiaries, employers, and private health insurers to determine whether beneficiary had creditable prescription drug coverage prior to enrolling with Medicare Part D.Investigated beneficiary claims of “special circumstances” to excuse lack of creditable prescription drug coverage. Researched applicable statutes and regulations.Drafted decision letters explaining determinations.Ensured compliance with CMS project standards, as well as applicable federal privacy statutes and regulations.Consistently exceeded targets for quality and productivity.

Working under Delaware's Student Practice Rule, independently managed juvenile misdemeanor arraignment and trial calendars in Family Court and assisted with adult misdemeanor arraignment calendar in the Court of Common Pleas.Wrote research memoranda involving various issues of criminal law.

J.D., Law

Activities and Societies: Member of the William & Mary Bill of Rights Journal Graduate Research Fellow

B.A., Psychology

Activities and Societies: Honors in Psychology Senior Thesis: Behavioral Patterns During a Social Skills Training Group