Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - - -
Professional Summary
Over 24 years in nursing including medical-surgical, longterm care, rehab, dermatology, plastic surgery. Ten years in Management including medical office management, store management. Experienced trainer/preceptor in medical data review and analysis. Proof of passing ICD-10 AAPC test. Five years in ICD-9, CPT coding, medical data abstraction, recent utilization review experience. Experienced in HEDIS, NCQA and CMS guidelines.
  • LPN
  • CPC
  • Currently in AAPC for CRC- Risk Adjustment Coding
Skill Highlights
  • ICD-9, ICD-10
  • InterQual, Milliman
  • Customer Service
  • HCC Coding
  • Preceptor/Educator
  • Chart Abstraction
Professional Experience
08/2015 to Current
HEDIS Quality Consultant Nurse Affinity Health Plan Inc Bronx, NY,
My current focus is CIS- Childhood Immunizations Status but I have worked Closely with Over 12 NCQA HEDIS measures. Initial chart reviews, finale chart over-reads and approvals, medical data collection/abstraction.Provider outreach, hospital outreach, member outreach.  Familiar with Qnxt, ImmuNet, NextGen, CRISP.
03/2015 to 05/2015
Seasonal HEDIS Review Nurse Marriott International Grapevine, ,
HEDIS review nurse, data abstraction of medical charts. Seasonal temporary work only.
02/2014 to 09/2014
Utilization Management Nurse Wexford Health Source City, STATE,
Participate in collegial review with Statewide Physicians and Regional Physicians of patient cases for medical necessity, applying Milliman and InterQual guidelines to justify decisions. Data entry of ICD-9, CPT codes, distribution of claims approval. Review of claims process for later inquiry as needed.
07/2011 to 01/2012
Preceptor-Trainer Inovalon, Inc City, STATE,
Train and evaluate nurses and CPCs in Medical Data Abstraction, ICD-9, HCC review and HEDIS abstraction.
2010 to 04/2011
Medical Record Review Nurse Consultant Inovalon, Inc City, STATE,
Medical record review consultant in Risk Adjustment Quality. Promoted to CES-Clinical Education Specialist where I did HCC abstraction,  ICD-9 coding, chart audits, development of instructional material. Experienced in projects: HCC, CARA, DRG, HEDIS, and Claims Integrity. Experienced in the following operating systems: SRSA, DCT, Microsoft Power Point, and Microsoft Office/Word.
2007 to 11/2015
Co-Owner Savvy Investment Properties LLC / Schaechtel Property Management LLC City, STATE,
Small Family Business with my husband and I purchase property as rental or remodel and sale.  Staff of 1-7 depending on sub-contractors on given job site. I also deal with clients. Fielding phone calls, meeting with potential renters and doing background checks, credit checks, verifying employment etc. [We shuttered our company the end of 2015.]
Education and Training
Expected in 1991
Associate of Arts: Licensed Practical Nursing
Union Memorial Hospital School of Nursing - Baltimore, MD
Nursing License #LP26522
Expected in 2014
Certification: CPC
AAPC - Baltimore, MD
Certified Professional Coder ID #01356982

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

  • Union Memorial Hospital School of Nursing
  • AAPC

Job Titles Held:

  • HEDIS Quality Consultant Nurse
  • Seasonal HEDIS Review Nurse
  • Utilization Management Nurse
  • Preceptor-Trainer
  • Medical Record Review Nurse Consultant
  • Co-Owner


  • Associate of Arts
  • Certification

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

*As seen in:As seen in: