Jawon L Jones
Deerfield
Summary
Accomplished and compassionate case manager highly driven professional with over 15+ years of experience in the healthcare industry, excelling in prior authorization, insurance verification, referral coordination, and Medical records management. Proven ability to manage high call volumes while ensuring HIPAA compliance and delivering exceptional customer service. Adept at case management and fostering collaboration, consistently achieving high-quality outcomes.
Overview
13
13
years of professional experience
Work History
Patient Access Case Manager
Eli Lily
Deerfield
01.2025 - 04.2025
- Managed client cases through assessment and coordination of services.
- Facilitated communication between clients, families, and healthcare providers.
- Monitored client progress and adjusted care plans as necessary.
- Conducted regular follow-ups to ensure service delivery and satisfaction.
- Educated clients on available resources and community support options.
- Monitored client progress through regular follow-up contacts.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
- Participated in regular team meetings and in-house training sessions to boost group effectiveness.
- Communicated with vendors to order supplies needed for patients' daily needs.
- Ensured adherence to all relevant laws, regulations, policies and procedures governing the care of patients.
- Identified gaps in service delivery systems and designed interventions to improve outcomes for patients.
Prior Authorization Intake Representative
Cigna/Evicore
09.2023 - 12.2024
- Skillfully managed a daily average of 100-125 inbound calls from health plan clients, providers, and imaging centers, ensuring prompt and accurate preauthorization assistance.
- Adhered to strict confidentiality standards under HIPAA and PHI regulations while handling and verifying patient records during each call.
- Demonstrated expertise in insurance verification, including commercial HMO, PPO, Medicaid, and Medicare plans, showcasing a profound understanding of technical medical terminology.
- Proven track record in obtaining prior authorizations for various exams through platforms such as Evicore, AIM, Healthcare Partners websites, and direct communication with insurance companies.
- Exhibited exceptional communication skills, both over the phone and in person, maintaining a high level of professionalism and efficiency.
- Maintained the highest standards of service quality through vigilant monitoring and proactive reporting of potential problems to the supervisor.
- Established and maintained regular communication with the Veterans Affairs department.
- Compiled and analyzed information, preparing insightful reports to support decision-making processes.
- Proficiently handled a daily volume of 100-125 inbound and outbound calls, providing timely pre-authorization support for Health Plan clients, providers, and imaging centers.
- Led remote support teams and actively participated in triaging over 80 high-volume cases, demonstrating versatility in communication across multiple channels.
- Instrumental in resolving 9,000 records, exhibiting strong leadership and organizational abilities.
- Managed unresolved records with meticulous attention to detail and analytical precision, ensuring efficient resolution and maintaining high standards of quality and accuracy.
- Experienced and results-oriented Customer Service Professional with a successful career spanning more than ten years.
- Skilled in efficiently managing a high volume of inbound calls and providing timely and accurate pre-authorization assistance to Health Plan clients, providers, and imaging centers.
- Proficient in insurance verification for a variety of plans, with a deep understanding of complex medical terminology.
- Demonstrates a commitment to maintaining strict confidentiality in accordance with HIPAA and PHI regulations.
Patient Support specialist (Remote)
Cancer centers of America
04.2020 - 08.2023
- Led the triage process for 80+ high-volume client, patient, clinician, and provider support cases, demonstrating adaptability across various communication channels.
Enrollment specialist
Rush university hospital
12.2017 - 04.2020
- Managed inbound and outbound member and provider inquiries, efficiently resolving benefit, eligibility, and customer issues.
- Conducted welcome calls for new members, conducting Health Risk Assessment Surveys to enhance member engagement.
- Provided member education, aiding in PCP selection, and facilitating access to care and wellness programs.
- Demonstrated proficiency in resolving inquiries on the first contact, emphasizing prompt and satisfactory resolution.
- Efficiently utilized available resources to ensure customer satisfaction and effective issue resolution.
- Demonstrated commitment to customer satisfaction by addressing inquiries with efficiency and empathy.
Customer service/Sales support
Bath and Bodyworks
08.2015 - 09.2017
- Operated within SAP to handle inquiries, orders, returns, shipment status, and product-related matters for customers.
- Collaborated seamlessly with sales reps, customers, and internal departments, ensuring clear and effective communication.
- Proactively resolved transaction discrepancies and customer complaints, ensuring immediate and long-term resolution.
- Provided detailed first-line responses to product questions, offering order numbers, descriptions, and suggesting products based on customer requirements, including tracking information.
- Demonstrated efficiency in order processing, modification, and communication, maintaining accurate internal data.
- Proactively obtained and documented customer feedback, contributing to continuous improvement initiatives.
Appointment Schedule Representative
Wiess hospital
07.2012 - 08.2015
- Coordinated and booked appointments for clients, patients, or team members, ensuring optimal use of time and resources.
- Maintained and updated calendars, ensuring all appointments are accurately reflected and any changes are communicated promptly.
- Interacted with clients or customers via phone, email, or in-person to schedule appointments and provide information as needed.
- Sent reminders and confirmations to clients via text, call or email to remind members to reduce no-show rates and ensure smooth operations.
- Managed and processed appointment changes, cancellations, and rescheduling requests efficiently.
- Maintained accurate records of appointments, client interactions, and any relevant notes in scheduling software or databases.
- Worked closely with other staff members to ensure that appointments align with overall business operations and staffing availability.
- Addressed any scheduling conflicts or issues promptly and professionally.
- Generated reports on appointment statistics and trends as needed for management review.
Education
Certifitcation - HIPAA Compliance Certificate
Alison Empower Yourself
06-2025
Certifitcation - 36 Hour Activities Director Certification
Oakton Community College
Des Plaines, IL07-2009
High School - General Studies
Nicholas Senn High School
01.2004
Skills
- Handling inbound/outbound calls
- HIPAA compliance
- Insurance verification
- Prior authorization
- Medical records maintenance and documentation
- Quality assurance, efficiency, and empathy
- Systems monitoring and reporting
- Task prioritization
- Case management
- Patient intake procedures
- Collaboration and communication with teamwork
- Route messages
- Medical terminology knowledge
- Enrollment specialist
- Referral verification
- Precertification requirements
Professional Highlights
- Experienced and results-oriented Customer Service Professional with a successful career spanning more than ten years.
- Proficient in insurance verification for a variety of plans.
Timeline
Patient Access Case Manager
Eli Lily
01.2025 - 04.2025
Prior Authorization Intake Representative
Cigna/Evicore
09.2023 - 12.2024
Patient Support specialist (Remote)
Cancer centers of America
04.2020 - 08.2023
Enrollment specialist
Rush university hospital
12.2017 - 04.2020
Customer service/Sales support
Bath and Bodyworks
08.2015 - 09.2017
Appointment Schedule Representative
Wiess hospital
07.2012 - 08.2015
Certifitcation - HIPAA Compliance Certificate
Alison Empower Yourself
Certifitcation - 36 Hour Activities Director Certification
Oakton Community College
High School - General Studies
Nicholas Senn High School
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