Experience

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  Jones Healthcare Solutions

  • Owner

    • 2006 - Present

    Jones Healthcare Solutions conducts analytical and retrospective audits of healthcare claims; utilizing claims data, payment information, contractual agreements and / or CMS guidelines and regulations. This comprehensive examination of claims will maximize dollars due to your organization, minimize interruption to it's daily operations while maintaining a positive relationship with your vendors.Jones Healthcare has the expertise and programs to audit any and all UB-04 and HC1500 claims. We will find the dollars due you.

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  Health Net of Arizona

  • Senior Financial Analyst

    • 2000 - 2006

    During my stint at Health Net, I developed a process to identify claims processing deficiencies, recommended system improvements, and supported any financial recoveries.I also developed a medical expense 'roll-up' model for budgeting and forecasting purposes. This model measured contract negotiation effectivenes, helped price all product lines, and allowed medical management idenity potential utilization issues.

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  PRG-Schultz

  • Senior Financial Auditor

    • Aug 1998 - Jan 2000

    Managed Direct Store Delivery (DSD) audit project, collaborating with IT group to develp and program DSD audit process, potentially recovering $8M for grocery client. Prior year's DSD audit project recovered 2.5M.Idividually able to identify, verifiy by vendors, and submit billing for $1.3M in recoveries for smallest division of client in just 3 months.

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  MasterCard International

  • Global Settlement Operations Analyst

    • 1994 - 1998

    Responsible for $1B+ debit card activity system between United States and European operating systems. I, along with another debit analyst, created accurate daily and monthly accounting reports for CIRRUS senior management. Was part of international operations team that identified financial liabilities between two stand-alone networks. I worked directly with IS programmers to identify, develop potential solutions, and teste results through daily and monthly reporting.