Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:

Motivated HIM specialist with over 8 years of experience in direct patient care, health operations management, insurance verification and authorization, billing, and coding. Expertise in DRG-patient assignment, ICD-10, CPT, and HCPCS coding. Highly skilled in analyzing and validating patient information, diagnoses, and billing data. Demonstrated leadership skills that enable the processing of high volumes of patient information to achieve results driven success.

  • Regulatory compliance understanding
  • CMS guidelines
  • Revenue cycle management
  • Insurance Billing
  • Insurance Forms Processing
  • Benefits Explanation
  • Insurance Authorizations
  • Certified Medical Coder
  • ICD-10 Coding
  • CPT coding
  • DRGs Patient Assignments
  • HCPCS Compliance
  • EMR Systems
  • Epic Systems
  • Records Management
  • Records Review
  • Compliance Verification
  • Microsoft Office
Insurance Coordinator, 11/2015 - Current
Lehigh Valley Hospital & Health Phillipsburg, PA,
  • Validated insurance and advised patients of benefits and coverage.
  • Verified patients had proper insurance coverage prior to procedures or appointment scheduling.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
  • Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Complied with insurance regulations dictated by local, state and federal agencies.
  • Secured pre-authorizations and pre-certifications for procedures.
  • Filed insurance claims by obtaining and entering data related to patient, insurance provider and medical code for procedures and services provided.
Office Staff Nurse, 12/2014 - 11/2015
Regal Cinemas Corporation Fort Walton Beach, FL,
  • Reviewed patient chart information before visit, ordered necessary laboratory tests, escorted patient to examination room, obtained vital signs and conducted interview to update records.
  • Responded to routine patient inquiries, assessed patient needs, conferred with physician regarding care plan and assisted physician with sensitive components of examinations.
  • Measured average of 30 patients' weight, height, body temperature, pulse rate and blood pressure each day.
  • Inoculated and vaccinated patients to immunize against communicable diseases.
  • Prepared and administered vaccines, medications, controlled substances and narcotics as prescribed and sterilized and stored instruments, equipment and supplies.
  • Completed electronic documentation, prior insurance authorizations and scheduling of appointments for patients prescribed for diagnostic and therapeutic services from specialists.
  • Educated patients in regards to office policies, medical procedure steps, recovery measures and medication instructions.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Coordinated with healthcare team to establish, enact and evaluate patient care plans.
  • Stocked clinical workstations and procedure rooms with necessary supplies.
Staff Floor Nurse, 05/2013 - 12/2014
Cape Cod Healthcare Inc. Plymouth, MA,
  • Explained patient conditions, procedures and treatment protocols to patients and families.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
  • Administered oral, IV and intra-muscular medications and monitored patient reactions.
  • Provided skilled direct nursing care to Adult patients in Cardiac/Respiratory department.
Health Unit Coordinator, 05/2011 - 05/2013
Baptist Health City, STATE,
  • Communicated with patients and medical staff to convey important information and facilitate smooth unit operations.
  • Maintained unit supplies and equipment for medical staff and patient care needs.
  • Transcribed physicians' orders to aid in medical care and minimize medical errors.
  • Created and maintained accurate and confidential patient files according to regulatory mandates.
  • Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
  • Updated patient financial information to promote accurate record keeping.
  • Coordinated office schedules for new patients, diagnostic assessments and procedures.
  • Helped patients complete paperwork and explained processes and procedures.
  • Assisted with hospital admissions and paperwork.
  • Prepared new charts, updated existing charts and managed records transfers between offices.
  • Contacted other medical facilities to confirm medical histories and prevent inaccurate diagnoses.
  • Adhered to all HIPAA requirements to safeguard patient confidentiality.
Education and Training
Bachelor of Science: HIM, Expected in 03/2016
Western Governors University - Salt Lake City, UT
  • Minor in Healthcare Administration
  • Completed coursework in Medical Coding, Healthcare Finance and Project Management
  • Completed continuing education in Medical Coding, Revenue Cycle, Managed Care, and Project Management
  • Excellence in Health Information Management Recipient
Associate of Applied Science: Health Science Technology, Expected in
WKCTC - Paducah, KY,
  • Completed Practical Nursing coursework
  • Florence Nightingale Compassionate Nursing Award Recipient
  • Completed professional development in Medical Coding, Certificate 5107163079
  • 3.8 GPA
  • Completed coursework in Nursing, Medical Coding, Healthcare Finance, and Medical Office Administration
Bachelor of Science: Biology, Expected in
University of Missouri - St Louis - St Louis, MO
  • Certified Coding Specialist CCS Certification - 2016-Current, AHIMA
  • Certified Revenue Cycle Representative CRCR Certification- 2016-Current, HFMA
  • Certified Specialist of Managed Care CSMC Certification- 2016- Current, HFMA
  • Certified Project Management Specialist PMP Certification - 2016-Current, Project+
  • LPN License - 2013-Current, Kentucky Board of Nursing

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School Attended

  • Western Governors University
  • University of Missouri - St Louis

Job Titles Held:

  • Insurance Coordinator
  • Office Staff Nurse
  • Staff Floor Nurse
  • Health Unit Coordinator


  • Bachelor of Science
  • Associate of Applied Science
  • Bachelor of Science

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