Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,
  • Jessica Claire Objectives Position utilizing my current; customer service, computer, and leadership experience to effectively enhance and add value to company operations. To succeed in an environment of growth and excellence and earn a job which provides me job satisfaction and self-development to help me achieve personal as well as organization goals. Seek challenging assignments and responsibility with an opportunity for growth and career advancement as a successfully achievement. Profile Nine years of continuous and progressive experience in; counseling, protective and rehabilitative services, customer service, and interpersonal skills.
  • Goal-oriented individual with strong leadership skills and abilities.
  • Organized, highly motivated, business oriented, detail-directed, and problem solver.
  • Flexible, lifetime learner, with excellent customer service and computer background.
  • Microsoft Office Suite software programs; Word, Excel, PowerPoint, Outlook
  • Knowledge of Medicare, Medicaid and commercial plans
  • Adaptable, Dependable, Determined and Responsible
  • Excellent verbal communication skills (vocabulary and articulation)
  • Ability to express assurance/confidence and empathy
  • Customer service experience
  • Detail-oriented
  • Documentation & Reporting
  • Leadership skills
  • Accounts payable and receivable
  • Interest calculations
  • Proficiency with CPR+
  • Invoice processing
  • Claims processing
  • Medical billing and collections
  • Coding proficiency
05/2019 to Current Billing Coordinator Bhdp Architecture | All Locations, OH,
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
  • Kept up-to-date with details of insurance plans and company requirements.
  • Liaised with patients, insurance companies and billing office personnel to effectively create and post bills, obtain payments and update system information.
  • Calculated figures such as discounts, percentage allocations and credits.
  • Verified proper coding on more than claims per week, investigating and resolving issues to maintain billing accuracy.
  • Performed insurance verification, pre-certification and pre-authorization.
  • Checked claims coding for accuracy with ICD-10 standards.
  • Submitted claims to insurance companies.
  • Participated in educational opportunities, including workshops, seminars and training classes to gain stronger education in industry updates and federal regulations.
  • Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
  • Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
11/2013 to Current Owner and CEO Carepathrx | Dallas, TX,
  • Planned and directed all functions of the company – Enforced strong leadership skills to ensure efficient/effective utilization of corporate resources.
  • Established and integrated the functional strategies of the company utilizing business expertise to reach financial/operational goals and objectives.
  • Deployed resources to achieve financial forecast and business objectives.
  • Record of success in guiding and directing an ABC enterprise through substantial change management, balancing engagement with strong and effective strategic leadership.
  • Developed sales and marketing plans and programs for company sales personnel.
  • Analyzed market trends and statistics to determine potential of growth – monitored sales performance regularly.
01/2019 to 05/2019 Intake Coordinator One80 Intermediaries | Westbrook, CT,
  • Utilize CPR+ to check eligibility, run test claims/reverse online claims as required.
  • Initiating and following up on Prior Authorizations.
  • Knowing and understanding how to properly calculate total drug cost based on the contracted rate between insurance and provider.
  • Point of contact between pharmacy, provider, and sales reps.
  • Organizing and managing daily morning meetings.
  • Initiating appeals and collecting appeal information as well as LMN’s to forward to insurance plan.
  • Knowledge of Commercial and Government plans.
  • Other duties assigned.
  • Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services.
  • Prepared and sent financial statements to support bookkeeping functions.
  • Updated group medical records and technical library to support smooth office operations.
  • Answered phone calls to provide assistance, information and medical personnel access to maximize office efficiency.
  • Supported administrative and healthcare staff, providing order fulfillment and inventory management services to ease operations.
  • Managed average of 15 patients per day and processed new claims utilizing appropriate adjudication system.
  • Investigated insurance policies to determine claim eligibility and processed files in accordance with instructions.
  • Automated office operations for managing client correspondence, payment scheduling, record tracking and data communications.
  • Distributed company correspondence, including memos and updates to reinforce and apprise departments and divisions of corporate objectives and developments.
11/2015 to 08/2018 Case Manager Mckesson/RxCrossroads | City, STATE,
  • Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing.
  • Ability to work in a fast-paced environment, handling both inbound and outbound calls.
  • Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines.
  • Good communication skills are essential, both internal and external.
  • Knowledge of Medicare benefits, enrollments and LIS assistance.
  • Plans and organizes work assignments, set priorities and completes work with a minimum of supervision.
  • Adheres to the service policy and principles of the company, as well as the program guidelines set by the department.
  • Participates in cross-training to perform all roles within the department.
  • Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners.
  • Other duties as assigned.
  • Process/reverse online claims as required.
  • Assign work equally throughout team.
  • Provide floor support, assist with supervisor/escalated calls.
  • Direct contact for client when management is out.
  • Train new case managers on job duties/responsibilities.
  • Responsible of submission of authorization forms to insurance plans.
Education and Training
Expected in 06/2008 High School Diploma | Jefferson County High School, Monticello, FL, GPA:
Expected in | Florida Agricultural And Mechanical University, Tallahassee, FL GPA:

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School Attended

  • Jefferson County High School
  • Florida Agricultural And Mechanical University

Job Titles Held:

  • Billing Coordinator
  • Owner and CEO
  • Intake Coordinator
  • Case Manager


  • High School Diploma
  • Some College (No Degree)

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