Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,

Motivated professional offering 10 year experience in the Healthcare field. Adds value to any organization in need of great collaboration, interpersonal, and multitasking abilities. Meets tight deadlines every time. Energetic leader successful at motivating and building positive team dynamics to accomplish aggressive goals. Dedicated to open, communicative culture where employees feel empowered to contribute to company's success.

Flexible hard worker ready to learn and contribute to team success.

  • Culturally aware
  • Troubleshooting
  • MS Office
  • Team Building
  • Critical thinking
  • Analytical
  • Multitasking
  • Working collaboratively
  • Work ethic
  • HIPAA compliance
  • Medical terminology
  • Claim validity determination
  • Insurance claims management
  • Friendly, positive attitude
  • Inbound and Outbound Calling
11/2018 to Current Clinical Appeals Team Lead Pain Stop Clinics | Gilbert, AZ,
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Collaborated with fellow team members to manage large volume of claims.
  • Train new employees
  • Analyze trends in insurance denials
  • Triage incoming inventory for the Appeal’s Team
  • Compose technical denial arguments for reconsideration.
  • Review accounts where an adjustment may or may not be present to clear potential inaccuracies.
  • Gather and prepare payor meeting agenda topics with feedback Revenue Cycle Leaders including Patient Access, PDU, Collections, Billing, RI and Payment Compliance as necessary.
  • Track progress of payor packages and claim escalations sent to payor
06/2012 to 11/2018 Top Dollar Account Specialist Concentra | Raleigh, NC,
  • Review UB-92, EOB’s, remits and payor correspondence in the course of performing account follow up and escalate any identified issues to the appropriate area for review and response to expedite claim resolution
  • Work with patients and guarantors’ to resolve payer request and discrepancies to promptly resolve pending claims.
  • Contact physician and/or insurance company to resolve issues regarding prior authorization or referral forms
  • Extensively researched delinquent accounts to identify key contact details, including current phone number and email address.
  • Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
  • Partnered with cash application team and credit manager on timely and accurate posting of remittances.
05/2006 to 05/2008 Medical Reimbursement Specialist Texas Health Resources Dallas | City, STATE,
  • Processed refunds on credit balances to maintain positive account relationships.
  • Expedited resolutions to correct customer problems and complaints.
  • Processed invoice payments and recorded information in account database.
  • Performed administrative tasks such as copying, scanning and mail sorting on daily basis.
  • Expedited payments by verifying accuracy and currency of payer information.
  • Submitted claims to insurance companies.
11/2005 to 05/2006 Cash Posting Specialist Jobnet | City, STATE,
  • Converted physical documents via scanning into electronic files and images.
  • Reviewed electronically scanned document images to verify accuracy.
  • Investigated and resolved issues to maintain billing accuracy.
  • Calculated discounts, percentage allocations and credits.
  • Reviewed and analyzed contracts to resolve billing issues with vendors and carriers.
  • Posted payments and sent reviews and denials.
  • Received payments from insurance providers, including Medicare, and completed immediate processing.
Education and Training
Expected in Associate of Applied Science | Associates of Science Victoria College, Victoria, TX GPA:
Expected in 02/2004 | Medical Office Assistant PCI Health Training Center, Dallas, TX GPA:

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School Attended

  • Victoria College
  • PCI Health Training Center

Job Titles Held:

  • Clinical Appeals Team Lead
  • Top Dollar Account Specialist
  • Medical Reimbursement Specialist
  • Cash Posting Specialist


  • Associate of Applied Science

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