Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
Professional Summary

Motivated Provider Enrollment Professional bringing experience successfully managing and monitoring eligibility information for members and groups. Highly skilled at facilitating program approval or denial through qualifications assessment, fact checking and record keeping. Confident and committed to promoting positive customer outcomes through dynamic communication and exemplary engagement skills.

  • Corporate Communications
  • Organization and Time management
  • Planning and Coordination
  • Leadership
  • Knowledgeable in EPIC
  • Proficiency in Cactus and MD Staff
  • Application Review
  • Microsoft Office
  • Troubleshooting
  • Claim Denials and Analysis
Work History
Patient Accounting Manager, 04/2016 to Current
Providence Health & ServicesMukilteo, WA,
  • Develop new department with existing personnel from other departments.
  • Manage six groups with unique tax identification numbers and billing structures; including urgent care, hospital based billing, and provider based billing.
  • Denied claim review and resolution for issues related to Provider Enrollment and coding issues.
  • Implement database for use by Provider Enrollment, used organizationally for source of truth.
  • Working with CAQH to use Delegated Reporting feature.
  • Create policies and procedures for Provider Enrollment.
  • Reduced average professional billing accounts receivable due to provider enrollment issues by $1.5 million in less than six months.
  • Claims denial management for provider enrollment and contracting issues.
  • Managed Care contracting, emphasizing reporting requirements for delegated and non-delegated groups.
  • Project Manager for development of LEAN principles for departmental development, software implementation, and establishment of new communication procedures.
  • Formulate career ladder designed to promote personnel from entry level to industry expert.
  • Manage employee issues.
  • Establish and maintain internal relationships with Senior Leadership and communicating Provider Enrollment needs and impact of organizational success.
  • Maintain external relationships with payor representatives.
Payor Credentialing Coordinator, 12/2013 to 03/2016
Ibm CorporationBoulder, CO,
  • Develop and implement department timelines and staffing needs for two tax identification numbers.
  • Determine if providers meet requirements for Payor Credentialing and communicate results to Medical Staff Office.
  • Decreased write-offs for provider enrollment related issues by 22% in less than 12 months.
  • Claims denial management for provider enrollment related issues.
  • Establish and maintain communications with internal and external contacts for reporting provider enrollment issues.
  • Managed Care contracting.
  • Capital expenditure charters.
  • Project Manager for new software implementation.
  • Establish and maintain internal relationships with Senior Leadership and communicate Provider Enrollment needs and their role in organizational success.
  • Maintain external relationships with payor representatives.
Recruitment Specialist, 06/2011 to 10/2013
Rv RetailerAlvin, TX,
  • Facilitate hiring processes between applicants and hiring managers.
  • Train mangers on conducting behavioral based interviews.
  • Publish job postings in local and national publications.
  • Manage up to 75 open positions.
  • Review applications for minimum requirements, conduct initial telephone interviews, and attend interviews.
  • Reference checks, employment verifications, and make hiring recommendations.
  • Compute and negotiate pay rates, extend job offers.
  • Team lead for value stream mapping used to create training manuals.
  • Establish and maintain relationships with hiring managers and potential employees.
Office Manager, 09/2003 to 01/2011
Carter Oil Company, IncCity, STATE,
  • Manage and delegate team workloads for corporate accounting staff of eight.
  • Established efficient workflow processes, monitored daily productivity and implemented modifications to improve overall effectiveness of personnel and activities.
  • Contract negotiation for fuel supply and delivery to independently owned and operated gas stations.
  • Work with major oil companies to contract for branding of new stations.
  • Review and approve credit applications and set credit limits for personal and business account holders.
  • Inventory reconciliation for convenience stores and corporate office oil sales.
  • Responsible for completion of fuel tax reporting.
  • Corporate payroll and human resources management; including preparation of semi-monthly payroll, quarterly and annual payroll reporting, hiring employees, and employee relations for over 75 employees.
  • Budgeting and general ledger account maintenance.
Master’s: Business Administration, Project Management, Expected in 08/2017
Ashford University - San Diego, CA
Bachelor of Arts: Human Resources Management, Expected in 01/2016
Ashford University - San Diego, CA

Member of Golden Key International Honour Society

Strong leader in healthcare using motivational techniques to develop and keep teams engaged in the success of the organization. Proven track record of reducing accounts receivable and write-offs related to claim denials.
  • Guest speaker at CAQH Delegated Reporting Symposium May 2019
  • Provider Enrollment Specialist Certification,

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Resume Overview

School Attended

  • Ashford University
  • Ashford University

Job Titles Held:

  • Patient Accounting Manager
  • Payor Credentialing Coordinator
  • Recruitment Specialist
  • Office Manager


  • Master’s
  • Bachelor of Arts

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