Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
Professional Summary

Driven Healthcare professional with 15 years of hands on experience in a
fast-paced healthcare environment. Very motivated and compassionate
about my work and job duties. Patient care and wellness is my strong
focus which I'm very responsible and accountable for. Highly
professional and organized Healthcare Industry with a solid experience
in managing and overseeing daily office operations in healthcare as well
as coordinating medical and administrative staff to deliver high-quality
Healthcare services. Possess excellent communication, leadership, and
multi-tasking skills along with the basic knowledge of medical principles,
terminology, laws, and ethics to ensure smooth running of medical
practice. Well organized and detail-oriented with the skill to grasp
complex situations. Experienced in HEDIS,
NCQA and CMS guidelines

  • Ability to be professional, thorough and organized; able to follow standard operating policies and procedures
  • Ability to maintain reasonably reliable attendance
  • Exceptional communications skills with the ability to transfer knowledge and optimize learning
  • Ability to meet and maintain production and quality standards
  • Ability to work independently or collaborate in a group environment
  • Ability to motivate and coach others
  • Ability to provide specific instruction in order to achieve results
  • Ability to take initiative to assist and support associates in order to meet department goals
  • Ability to identify, gather necessary information, and resolve problems in a timely manner
  • Ability to work safely and adhere to safety guidelines in a warehouse environment

Computer: HEDIS, NCQA, CMS,
E-clinical Work, Medtech, NextGen,
Cairo, STNA, Advance Med, Allscripts,
Athena Health, Cerner, Practice Fusion,
Advance MD, ChartLogic, Greenway and
Microsoft Office Suite.
HEDIS Review,HEDIS Abstraction,
NCQA, EMR, Diagnosis code, Microsoft
word, Excel, Power point DARTH,
Health-EC, QSHR,Optum, Care-Analyzer,
SAP, Cognos. EPM, Axiom Software

Work History
Medical Legal Assurance Specialist, 06/2019 to 12/2019
Wexford Health Sources IncBelleville, IL,
  • Perform complaint and quality investigations related to
    manufacturing, design or clinical use issues.
    Review and approve investigations performed by OEM supplier
  • Managed large volume of medical claims on daily basis.
  • Ensure consistency to detail in performing and documenting
    complaint investigations
  • Evaluates complaints for determining MDR/Vigilance events and
    document rationale for not filing
  • Determine whether a product malfunction or serious injury reports
    needs to be filed with the FDA.
  • Determine whether a 30 day or 5-day MDR report is required.
  • Maintain the records of all MDRs and document rationale for not
    filing MDRs
  • Create MDRs for review by the Clinical Risk Specialist and also
    develop inquiry reports to the hospitals
    on reported complaints.
  • Perform final review for closure of complaint files to ensure accuracy,completeness, and attention to
  • Generates results letters to customers and maintain all required
    records for the complaint.
  • Approve decision trees for vigilance reports/international competent
  • Handle competent authority inquiries of complaints and Other duties
    as assigned.
Practice Operations Training Analyst(promotions), 03/2013 to 05/2019
Healthcare ConsultantsCity, STATE,
  • Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
  • Plans, implements and evaluates Epic ambulatory EMR and professional revenue cycle training
  • Maintain a central database on practice management applications by practice: users, locations, use of scheduling system, automated encounter form, etc
  • Assists in the development and maintenance of the policy and procedure and training manuals
  • Set training schedules and review expectations with Hackensack University Medical Group physician practice staff and leadership
  • Assist with quality control review of processes and daily monitoring of status of backlogs
  • Develop agenda and facilitate Front End Users meetings to disseminate information on revenue cycle operations to designated physician practice staff
Healthcare Analyst/ Quality Improvement Specialist, 08/2008 to 02/2016
Healthcare ConsultantCity, STATE,
  • Assured consistent quality of production by implementing and enforcing automated practice systems.
  • Developed quality improvement plans, policies and operational
  • Provide team leadership and project management
  • Extracted, transformed and loaded data utilizing SAS ETL studio
    Responsible for researching health data and records by interpreting
    patient data into reports
  • Compile and analyze patient claims to access performance and
    efficiency relative to available medical models
  • Develop and provide regular reports from company's vendors and
  • Review all data from a variety of sources to ensure integrity, validity
    and accuracy
  • Assist with structuring of request programming
  • Create data sets for analysis using database and analytic tools
  • Provide analytic support to patient quality improvement teams
Medical Records Director, 03/2003 to 08/2004
Liberty Nursing&Rehab CenterCity, STATE,
  • Identified new methods to optimize medical records management.
  • Maintained accuracy, completeness and security for medical records
    and health information.
  • Adhered to all confidentiality requirements at all times.
    Demonstrate initiative by organizing and closing out all charts of
    residents in a 281 bed facility.
  • Research all current and closed charts for appropriate forms and
  • Participated in committees to discuss topics, including electronic
    health records and methods that would improve overall workflows.
  • Manage a team of Ward clerks, and assist in their daily routines of
    maintenance of the medical records.
  • Designed and introduced leadership development, coaching and team
    management model, resulting in promotion of employees into
    increased levels of responsibility.
  • Take on weekends duties, helped mealtime preparation, and perform
    hall monitoring.
  • Create a functioning file method of filing medical records within
    compliance of the State of North Carolina.
  • Handle all aspects of Medicare Certifications, and Re-Certification
Bachelor of Science: Healthcare Administration, Expected in 06/2008
Columbia Southern University - Orange Beach, AL
Next Level Healthcare Training - Atlanta, CA,
Certificate: Advanced Medical Coding, Expected in 12/2014
Kennesaw State University - Kennesaw, GA,

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Resume Overview

School Attended

  • Columbia Southern University
  • Next Level Healthcare Training
  • Kennesaw State University

Job Titles Held:

  • Medical Legal Assurance Specialist
  • Practice Operations Training Analyst(promotions)
  • Healthcare Analyst/ Quality Improvement Specialist
  • Medical Records Director


  • Bachelor of Science
  • Certificate

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