1. Debra A. Jones
7777 Normandy Blvd Apt 1218
Jacksonville, Florida 32221
Mobile: 757-316-6328
Email Address: Jon7debor@aol.com
Resourceful and diverse producer with vast skills and abilities that span more than two decades in
human services, Healthcare commercial insurance, Medicaid, Medicare, Medicare Advantage, Patient
Services, sales, claims, the establishment of long-term lucrative relationships, comprehensive product
knowledge and superior client services.
Interpersonal and articulate, able to pursue initiatives that capitalize on strengths and opportunities,
and proven to successfully identify and shepherd the process from the first meeting to the closing of
transactions.
Excel in the management and mentoring of others with an innovative approach that encourages and
enables attainment/exceeding of imposed goals and objectives, a collaborative team approach and the
desire to succeed.
PROFESSIONAL HISTORY
Provider Service Advocate
August 2015 – Present
First Coast Service Options- Jacksonville Florida
Respond to Medicare Part A telephone inquiries from the Medicare provider community regarding
coverage guidelines and policies covering a wide range of topics to include provider enrollment,
Medicare appeals, debt recovery, claim payment information, telephone reopening requests, and
general coverage for multiple provider specialties. Access the IVR and Internet Portal systems as
needed to help educate customers on self-service options that are available to them. Access the IVR and
Internet Portal systems as neededto help educate customers on self-service options that are available to
them. Analyze claim edits and audits to determine reasons for claim denials. Review local medical
coverage and national medical coverage policies in order to troubleshoot reasons for claim denials and
reductions. Review other system to address and determine resolution to other customer issues to include
pending appeals, aged claims, and Medicare Secondary Payer. Customer Service. Engage in dialogue
with all customers using a customer-friendly tone evenwhen challenged with overly aggressive
customers. Respond to each customer’s need and request and ensure each customer’s encounter is
positive and productive. Use good verbal communication during each customer encounter and never
use jargon and slang during customer calls. Embrace diverse backgrounds and understand the needs of
those customers who may not have as extensive knowledge of Medicare rules and regulations. Tailor
responses to ensure customers receive the maximum benefit when calling Medicare.

2. Utilization Management Manager 1
December 2012 – April 2015
Anthem BCBS –Virginia Beach VA
Provided supervision and technical support to the Medicare Advantage Case Specialists referrals team.
Managed staff to meet or exceed department goals, including productivity metrics, quality and timeliness as
defined by department guidelines. Monitor and manage call volumes. Ensuring that staff adheres to
departmental guidelines, providing direct feedback and coaching. Supervise implementation of procedures in
concert with contract requirements and federal and state laws. Serve as departmental liaison to internal and
external associates and customers. Interact with other departments in development of technical training and
user documentation to assist in the support and training of all staff. Facilitate training on systems and
departmental policies and procedures. Lead team meetings to keep associates abreast of Company and
Departmental activity. Recruit, hire, schedule, train, coach and manage Case Specialist team performance,
ensuring compliance of all regulatory requirements.
Eligibility Supervisor
October 2008 to August 2011
First source LLC – Portsmouth, VA
Provided Staff Supervision to Medicaid/Disability Eligibility Service Reps, which included interviewing,
hiring, and training new staff members, facilitated team meetings, scheduling, payroll, employee development,
assigning work, direct activities, monitored work quality and performance evaluation, and issued performance
improvement plans (PIPs) when necessary. Promoted public relations; resolved and provided timely responses
to concerns, complaints, and conflicts. Assisted with contract implementations, managed program activities,
monitored program compliance, gather information, analyzed data, evaluated trends, and developed plans of
action. Monitored multiple databases to keep track of all company inventories. Created and prepared a variety
of daily, weekly, monthly, and annual reports for distribution to management, administrators, staff, and client
base. Made monthly visits to local sites, with frequent overnight stays to surrounding sites. Coordinated the
delivery of services among various departments and service.
Substitute Teacher
September 2007 to October 2008
Portsmouth Public Schools – Portsmouth, VA
Taught students basic academic, social, and other formative skills in public or private schools at the K-12
level. Followed and created lesson plans. Kept students on task during the absence of their permanent
teacher. Created and maintained a climate of respect and fairness for all students.

3. Senior Outreach Specialist
July 1998 to April 2007
Anthem BCBS – Virginia Beach, VA
Developed and fostered partnerships and awareness in the community and state by educating and servicing
existing and potential members, facilitated group presentations. Managed community outreach initiatives
which included health information that promoted healthy lifestyles, developed communication strategies to
increase awareness of health plan services and the community services that supported the Medicaid and
Commercial population. Represented Anthem by participating on boards and committees of significant
community organizations to increase awareness of the health plan. Coordinated community health fairs and
special events. Made home visits to new and existing members. Identified and addressed barriers to care, and
assisted clients with making appointments and needed services.
Provider/Member Service Representative
November 1996 – July 1998
Anthem BCBS Virginia Beach, VA
 Handled inbound telephone inquiries
 Verified plan benefits and eligibility
 Investigated and resolved service issues
 Coordinated member transportation.
EDUCATION & LICENSES
Saint Leo University 2006
Saint Leo, FL
Bachelor of Arts (BA)
Major: Sociology/Minor Criminology