Jon De Leon Email & Phone Number

Oakland, California, United States

Oakland, California

• Generate reports for the Coding & Reimbursement Team displaying total monthly team cost savings• Perform intake and assign 20-30 provider dispute CRMs daily to the Provider Disputes Team• Perform provider outreach by calling and sending emails to providers in order to follow up on invitation to contract directly with Kaiser Permanente• Notify providers of expiration of provider credentials, provider licenses, and CAQH information• Presented detailed presentation introducing the use of Microsoft Teams for department use and maintained staff support• Maintained the Line Item Deduction Itemized Bill Review project by coordinating with different teams in order to proceed with the project• Generate detailed reports regarding high costs claims in order to estimate average annual savings for IBR project• Developed workflow detailing process from receiving provider dispute to resolution for IBR project• Developed step by step DLP for provider dispute process in IBR project

San Francisco Bay Area

• Utilize Zendesk program to communicate and resolve any provider or member related inquiries and issues on claims that are denied or encounter processing errors, and provide insight and clear detailed explanations regarding a claim's status• Reduced the volume of Zendesk dispute tickets from 804 tickets in February, 2018 to 54 tickets in December 2018• Analyze trends by observing numerous claims that are denied for the same EOB denial code in order to determine the root cause of the claim’s denial• Assist providers submitting claims that encounter submission errors including missing, invalid, incorrect, or illegible information as well as claims that have not been received• Price inpatient, outpatient, home health, and skilled nursing facility claims according to the CMS regulated pricing tool• Price anesthesia, ambulatory surgery center, and medical professional claims according to the CMS regulated provider fee schedules• Price DME claims according to the CMS regulated DME fee schedule• Ensure in-network providers are paid at the correct contracted rate and resolve any disputes regarding contracted rates• Review and process medical, hospital, durable medical equipment, skilled nursing facility, and specialty claims within a 30-day time frame• Monitor inpatient claims for fraudulent billing of Sepsis DRG and hospital readmissions within 30-days of patient discharge for research by the Utilization Management Team• Assisted with matching appropriate Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) to 200 EOB codes for the company's new claims processing program, HealthEdge

United States

• Prepared and presented 60-80 medically necessary contact lens requests monthly to the Clinical Director for clinical review and ensured all cases were completed within the 5 business-day deadline.• Generated approval and denial letters for medically necessary contact lens requests based on the Clinical Director’s determination.• Generated acknowledgement letters and ensured letters are mailed within 5 calendar days of receipt for appeals and grievances.• Prepared and presented patient appeal cases to the Administrative Review Committee and grievance cases to the Client Relations Committee on a weekly basis.• Processed claims approved by the Administrative Review Committee and Client Relations Committee timely within the check write deadlines each month.• Contacted providers to request additional information regarding grievance filed against them including written narrative, patient prescription, and invoice for services rendered.• Generated resolution letters for appeals and grievances and ensured letters are mailed within 21 calendar days, never to exceed 30 calendar days.• Generated Explanation of Payment and Proof of Coverage letters to providers and patients as requested.• Prepared a weekly dashboard overview of all appeals, grievances, refund request, medically necessary requests, and patient satisfaction surveys for review by the Team Leader.• Collaborated with the Accounting Department to generate letters and checks to pay claims that accrue interest due to a delay in claim processing within the 5 business-day deadline.

United States

• Prepared and presented 60-80 medically necessary contact lens requests monthly to the Clinical Director for clinical review and ensured all cases were completed within the 5 business-day deadline.• Generated approval and denial letters for medically necessary contact lens requests based on the Clinical Director’s determination.• Generated acknowledgement letters and ensured letters are mailed within 5 calendar days of receipt for appeals and grievances.• Prepared and presented patient appeal cases to the Administrative Review Committee and grievance cases to the Client Relations Committee on a weekly basis.• Processed claims approved by the Administrative Review Committee and Client Relations Committee timely within the check write deadlines each month.• Contacted providers to request additional information regarding grievance filed against them including written narrative, patient prescription, and invoice for services rendered.• Generated resolution letters for appeals and grievances and ensured letters are mailed within 21 calendar days, never to exceed 30 calendar days.• Generated letters requesting refund of over payment on claims directed to both providers and patients and successfully received 80% of requested refunds of over payments for the 2016 year.• Prepared a weekly dashboard overview of all appeals, grievances, refund request, medically necessary requests, and patient satisfaction surveys for review by the Team Leader.• Collaborated with the Accounting Department to generate letters and checks to pay claims that accrue interest due to a delay in claim processing within the 5 business-day deadline.• Tabulated, researched, and prepared on average 300 patient satisfactory survey results quarterly for review by the Vice President.• Generated priority letters and returned misdirected claims and documents to promptly to senders.

Long Beach, California

Human Resource Team• Created and distributed a flyer for recruitment of the undergraduate internship program at the VA.• Contacted prospective candidates and scheduled appointment dates for interviews.• Conducted interviews and worked with 8 experienced applicants, examine and observe required transferable skills.• Directed and instructed students with Education Department onboarding process including submission of required paperwork, creating email accounts, and scheduling appointments.• Conducted an exit interview to receive feedback for future reference of their experience.• Result: Hired and completed processing for 11 interns in 6 weeks.Motor Pool Project• Manage the redesign of Motor Pool policy and implementation of a new electronic system for vehicle rental.• Documented data regarding GPS serial numbers for one hundred and 133 GPS devices in order to account for inventory.• Installed 5 GPS devices into vehicles in order to test pilot activation of devices on GPS Insight program.• Utilize GPS Insight program for driver setup, management, and tracking of vehicles.• Submitted weekly updates of GPS installation in vehicles to GPS Insight administrator via email.• Conducted a presentation for 2 Chief Operating Officers and presented a demo of how the GPS Insight tracking system works.• Result: 53 vehicles contain GPS devices and are being tracked on GPS Insight program.VetLink Kiosk System• Assisted with implementation of kiosks in the facility by notifying and informing clinic clerks of the value and use of kiosks.• Maintained and repaired kiosks in various clinics around the hospital, including refilling paper and restarting devices.• Configured settings for each clerk requiring access to patient records depending on the clinic they are located in.• Demonstrate how to filter patient queue settings to clerks beginning to use VetLink program.• Planned and coordinated with departments for possible locations for kiosk installation.

Lakewood, California

• Gathered items returned to library from outdoor book drop containers 3 times a day.• Sorted items by category according to the Dewey Decimal System in order to be placed in their correct shelves.• Shelved over 100 items including books, DVDs, CDs, VHS, and cassettes returned to the library daily.• Prepared daily newspapers on newspaper sticks to be available for viewing by the public.• Assisted patrons searching for particular items in the library with 90% accuracy of finding items.• Provided assistance on public computers with printing and computer programs including Microsoft Word, Excel, and PowerPoint.• Participated and assisted in preparing public programs including children's story time and other public events hosted at the library.

Long Beach, California

• Chaperone and accompany students on public transportation from school to the Veterans Affair Hospital in Long Beach.• Demonstrated leadership as a job coach for students in special education program by leading with an example behavior.• Assisted students with learning how to read or write by evaluating students for proficiency and accuracy on written tests.• Aided students in learning to become independent by teaching them simple jobs and tasks in a hospital setting such as cleaning tables, sweeping the floor, and sanitizing handrails.• Taught students how to escort patients in wheelchairs from or to clinic depending on patient location to promote independence.• Provided students corresponding lunch tickets to receive free lunch while volunteering at the hospital.• Aided teachers in preparing and monitoring during student testing of the California High School Exit Exam.• Assisted students during class sessions with students struggling on class assignments.