Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
Professional Summary
Billing and Revenue Manager with 23 years plus hands-on experience with a strong focus in A/R management, payroll, and general accounting in a busy medical office enviroment. 
Skill Highlights
  • Knowledge and experience in medical billing and claims procedure in a medical office setting
  • Experience with CPT, HCPCS, ICD-10 coding, and medical terminology
  • Knowledge of HMOs, Medicare and Medi-Cal
  • Proficient in Microsoft Office (Word, Excel)
  •  Experience with Falcon EHR software, pMD, Athenanet and PrimeClinial billing system
  • Staffing management ability​
  • Solid oral and written communication skills
  • Personal and professional integrity 
  • Financial aptitude
  • Conflict resolution
  • Relationship and team building
  • In-depth claims knowledge
  • Claims analysis and review specialist
  • Critical thinking proficiency
Professional Experience
Billing and Revenue Manager, 08/1994 to Current
Chabot Nephrology Medical Group, IncCity, STATE,
 Carefully selected, developed and retained qualified staff, as well as trained [number] new staff annually.
Evaluated patient care procedural changes for effectiveness.
Created annual goals, objectives and budget and made recommendations to reduce costs.
Assisted in the design and execution of programs that contributed to a [%]
growth of the organization in the [year] fiscal year.
Administered, directed and coordinated the activities of the agency.
Served as liaison between management, clinical staff and the community.
Expertly planned, coordinated, organized and directed all operations of the agency.
Expertly planned, coordinated, organized and directed all operations of the agency.
Directed the installation of improved work methods and procedures to achieve agency objectives.
Implemented standards and methods to measure the effectiveness of agency activities.
Cooperated with other health related agencies and organizations in community activities.
Ensured the accuracy of public information and materials.
Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.
Sourced and implemented new performance appraisal process.
Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.
 Jumped in to fill gaps for on call rotation when necessary.
Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed.
Monitored the nursing and operation of support departments to ensure that resident needs were met and facility was properly maintained.
Diligently monitored the QA (Quality Assurance) program to improve performance and maintain high standards of care.
Minimized staff turnover through appropriate selection, orientation, training, staff education and development.
Established and maintained positive relationships with government regulators, residents, families, other area health care providers, physicians and community at large.
Organized and led weekly personnel meetings with [number] team members.
Developed and managed budget and revenue expectations while actively seeking ways to eliminate or reduce expenses.
Corresponded with operations staff to ensure key client deliverables and revenue goals were met.
Closely monitored competitor activity, legislative and regulatory initiatives and agency concerns and contracts and developed strategies to respond.
Revised policies and procedures in accordance with changes in local, state and federal laws and regulations. Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
Actively served on Utilization Review Committee by reviewing policies, patterns of providers and sanction processes.
Contributed to and participated in community education projects to foster widespread understanding of the prevention and treatment of illnesses.
Observed strict confidentiality and safeguarded all patient-related information.
Coached and developed a care team that consistently ranked among the top in its region for key clinical, performance and financial outcomes.
Established facility's annual budget and conducted monthly reviews to ensure finances were being properly allocated.
Planned, organized, supervised and provided assignments for nursing, technical, office and biomedical staff. Managed an average of [number] employees each shift.
Reviewed and approved time cards for processing by payroll department.
Provided administrative and clinical leadership to the nursing staff and helped improve annual retention rate from [number] percent to [number] percent.
Conducted or approved the performance evaluations for all nursing department employees.
 Monitored staffing patterns and nursing care hours for efficiency and made changes when necessary.
Conducted probationary and annual performance evaluations of all nursing staff.
 Supervised and evaluated the activities of medical, nursing, technical, clerical, service, maintenance and other personnel.
Kept abreast of advances in medicine, computerized diagnostic and treatment equipment, data processing technology, government regulations, health insurance changes and financing options.  
 Thoroughly investigated past due invoices and minimized number of unpaid accounts.
Recorded and filed patient data and medical records.
Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
 Carefully reviewed medical records for accuracy and completion as required by insurance companies.
Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
 Acquired insurance authorizations for procedures and tests ordered by the attending physician.
Provided administrative support for three physicians.
Accurately entered procedure codes, diagnosis codes and patient information into billing software.
Consistently ensured proper coding, sequencing of diagnoses and procedures.
Quickly responded to staff and client inquiries regarding CPT codes.
Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
Received, organized and maintained all coding and reimbursement periodicals and updates.  
 Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.
Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
Analyzed and interpreted patient medical and surgical records to determine billable services.
Thoroughly reviewed remittance codes from EOBS/AR's.
Strictly followed all federal and state guidelines for release of
Efficiently performed insurance verification and pre-certification and pre-authorization functions.
Performed full-cycle medical billing in a fast-paced medical billing company.
Performed quality control of the data entry system to verify that claims and payments were posted correctly.
Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
 Meticulously tracked and resolved underpayments.
Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.
Applied payments, adjustments and denials into medical manager system.
Posted charges, payments and adjustments.
Completed appeals and filed and submitted claims.
Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
Confirmed patient information, collected copays and verified insurance.
Interpreted medical reports to apply appropriate ICD-10, CPT-4 and HCPCS codes.
Completed appeals and filed and submitted claims.
Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
Performed full-cycle medical billing in a fast-paced medical billing company.
Education and Training
: , Expected in 1992
EastBay California State, Hayward - Hayward, CA
Coursework included Business Administration and Accounting
: , Expected in 1990
Chabot College - Hayward, CA
Continuing education
High School Diploma: , Expected in 1987
James Logan High School - Union City, CA

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • EastBay California State, Hayward
  • Chabot College
  • James Logan High School

Job Titles Held:

  • Billing and Revenue Manager


  • High School Diploma

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: