Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary
An impact oriented health information professional with over thirty years of experience in the health information management field.  I’ve recently acquired a graduate degree in health informatics and would like to integrate this knowledge with my healthcare work experience
  • Strong presentation skills
  • MIPS and HEDIS quality measures
  • EHR meaningful use
  • Analysis of clinical and financial data and ICD-10CM coding.

Revenue cycle

Medicare Advantage

ACA, Healthcare Reform

Population Health


Work History
HEDIS Auditor and Data Analyst, 11/2014 - Current
Booz Allen Hamilton Inc. Buckley Afb, ,

Perform Medical Record Review to retrieve documentation for specific information related to HEDIS clinical measures

Met interrater reliability thresholds for performance prior to and throughout abstraction timeframe

Develop and maintain ACA preventive services database with appropriate codes and services covered by CMS, USPSTF, Bright Futures

Utilize GEMS and Reimbursement mapping of ICD9 and ICD10 for historical clinical data analysis

Experience navigating different EHR systems (Cerner, Allscripts, NexGen) for data collection and auditing of Population Health providers 

Coding and Payment Coordinatory, 08/2006 - Current
AultCare Health Plan City, ,

Analysis and data mining of external Fraud Waste and Abuse database using historical medical and pharmacy claims data. 

Identify, educate and prevent FWA by ascertaining appropriate coding rules, guidelines and claim editing. 

Advise PCMH offices on required documentation and data reporting of  electronic health records (EHR) for NCQA recognition   

Provide education to providers, office managers and staff regarding Medicare risk adjustment and the importance of documentation and  accurate coding of on-going chronic conditions for PTHP enrollees  

Optimized monthly capitation payments to Primetime based on targeted audits which resulted in additional payer revenue to provide coordinate care for enrollees with high level chronic conditions  

Project lead for member problem list development through data mining of claims to report confirmed chronic and suspected conditions based on clinical data reported on valid claims

Healthcare Consultant, 09/2004 - 07/2006
Independent Consultant City, STATE,

Conduct revenue recovery and data validation audits of medical record documentation with claims data to determine if charges, units and CPT codes correlate with services documented. 

Identified physician point of care services and procedures performed at patient bedside that were not captured through the chargemaster

Design and utilize audit tools to capture and monitor the accuracy of clinical coding

Presented a certified independent MS-DRG validation audit for Aultman LTAC required by external financial auditors for dates of services 2006-2010

Perform Encounter Data Omission Studies for Health Services Advisory Group, Medicaid QIOContract trainer for MedAssets (2005-2006)

Contract trainer for MedAssets (2005-2007) on Chargemaster (CDM) management software
Master of Science: Health Informatics, Expected in 2011
University of Illinois at Chicago - Chicago, on-line
Bachelor of Science: Health Information Management, Expected in
University of Central Florida - Orlando, Florida

RHIA    American Health Information Management Association    

CCS-P American Health Information Management Association

CCS   American Health Information Management Association  

NAHQ  Plan on taking Professional in Healthcare Quality (CPHQ) certification

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School Attended

  • University of Illinois at Chicago
  • University of Central Florida

Job Titles Held:

  • HEDIS Auditor and Data Analyst
  • Coding and Payment Coordinatory
  • Healthcare Consultant


  • Master of Science
  • Bachelor of Science

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