Jasmen Cobb
Collierville,TN
Summary
Detail‑driven Appeals Processing Senior Representative (Out‑of‑Network) specializing in analyzing complex disputes, interpreting state regulations, and resolving cases with strict adherence to mandated timelines. Strong expertise in OON pricing review, balance‑billing assessments, No Surprises Act applicability, benefit/contract analysis, and coding accuracy. Recognized for producing clear, defensible determinations and maintaining high levels of compliance, quality, and documentation accuracy.
Overview
5
5
years of professional experience
Work History
Appeals Processing Senior Representative (Out-of-Network)
Cigna Healthcare / Accredo
09.2024 - Current
- Resolve OON disputes (denials, pricing, high member liability, provider allowed amount challenges) with state law and policy alignment.
- Validate allowed amounts via geographic methods; adjust reimbursement when state minimums or policy require.
- Apply balance billing and No Surprises Act rules; assess OON at in-network facilities, emergency services, and IDR eligibility.
- Determine member liability
- Write citation-based determinations (state OON laws + benefit language); explain pricing & cost-share; maintain audit-ready files.
- Prevent escalations (DOI/State Arbitration/IDR) via accurate calculations, correct regulatory application, and clear rationale.
- Hit deadlines & quality in a high-volume queue; collaborate with pricing, claims, medical directors, provider relations, and compliance.
Eligibility Representative
Accredo Specialty Pharmacy
10.2020 - 09.2024
- Perform medical/pharmacy benefit verification requiring
complex decision skills based on payer and process
knowledge - Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Contact benefit providers to gather policy
benefits/limitations - Prepare and review claims to ensure accuracy to payer
requirements, including but not limited to codes, dates,
and authorizations - Established databases to track, analyze and automate eligibility application processes.
Education
AAS - Medical Assistant
Highline Community College
DesMoines, WASkills
- State regulations
- Dispute resolution
- Critical thinking
- Research & analysis
- Strict turnaround times
- Compliance
- OON pricing (geographic)
- Balance billing / No Surprises Act
- Benefit & contract interpretation
- ICD-10/CPT/HCPCS
- Determination letters
- EOB/claims analysis
- Audit-ready documentation
- Cross-functional collaboration
- Quality & timeliness metrics
Timeline
Appeals Processing Senior Representative (Out-of-Network)
Cigna Healthcare / Accredo
09.2024 - Current
Eligibility Representative
Accredo Specialty Pharmacy
10.2020 - 09.2024
AAS - Medical Assistant
Highline Community College
TOOLS
- Microsoft Excel, Word, Outlook
- Citrix
- Adobe
- Document management/workflow systems
- Claims/EDI (Facets, Proclaim)