Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,

Talented Prior Authorization Representative with years of implementing strategies to secure authorizations for clinical procedures. Expert delivering continuous clinical quality improvement. Superb influencing skills to communicate with credibility, tact and diplomacy.

Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking entry-level opportunities to expand skills while facilitating company growth.

  • Precertification requirements
  • Practitioner order verification
  • Understanding of medical terms
  • Insurance information oversight
  • Reliable and trustworthy
  • Communication
  • Multitasking
  • People skills
07/2016 to 08/2019 Prior Authorization Specialist Cvs Health | Hayward, CA,
  • Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Notified ordering providers of denied authorizations.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
  • Used [Software] to input claim, prior authorization and other important medical data into system.
  • Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
  • Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
  • Clarified patient inquiries and questions to update patient account information in computer system.
  • Collaborated with internal departments to provide account status updates.
  • Created master spreadsheet to record procedures, denials and approvals.
07/2016 to 08/2019 Discharge Receptionist Vidant Health | Roanoke Rapids, NC,
  • Scheduled and confirmed appointments.
  • Answered and directed incoming calls using multi-line telephone system.
  • Delivered administrative support to team members, including making copies, sending faxes, organizing documents and rearranging schedules.
  • Processed payments and updated accounts to reflect balance changes.
  • Managed more than [Number] incoming calls per day.
  • Coordinated and communicated with [Number] clients daily to gather pertinent information.
  • Answered phone calls, provided information to callers and connected callers to appropriate people.
  • Welcomed patrons to front desk and engaged in friendly conversations while conducting check-in process.
  • Screened and verified visitors for identification credentials and purpose of visit to maintain security of personnel and office environment.
  • Answered office phone and emails to schedule appointments, forward information and complete [Task].
  • Maintained front office cleanliness and organized supplies to increase [Type] task productivity.
06/2011 to 07/2016 Unit Secretary University Of Miami Miller School Of Medicine | Boca Raton, FL,
  • Executed clerical tasks and assisted with all unit duties as directed.
  • Managed unit call reception and routed calls to correct department.
  • Provided patient information to facilitate timely admissions and discharges.
  • Maintained strong and trusting rapport with patients and all healthcare staff to build relationships.
  • Answered phone calls to provide assistance, information and medical personnel access.
  • Monitored unit supply levels and notified management of ordering needs.
  • Retrieved physicians' paperwork, including lab test requests.
  • Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services.
  • Transcribed doctors' orders, including medication and lab test requests.
  • Compiled physical and digital documents, charts and reports.
  • Supervised order fulfillment and inventory management services to ease operations and support administrative and healthcare staff.
  • Developed improve training procedures to aid in team member development.
06/2010 to 07/2016 Certified Nursing Assistant Twin Lakes Regional Medical Center | City, STATE,
  • Assisted patients with shaving, bathing and oral hygiene to promote healthy habits and overall wellness.
  • Facilitated activities of daily living, including personal hygiene management, feeding and ambulation.
  • Conducted routine checks on standard patient vitals, including blood pressure, blood sugar and heart rate.
  • Exhibited compassionate care and communication regarding issues surrounding death and dying.
  • Managed and maintained patient rooms, shared-living areas and nursing stations.
  • Responded to patient alarms and needs-assessment requests to identify course of treatment.
  • Rendered hands-on nursing care under direct RN supervision, adhering to medical center policies and procedures.
  • Maintained accurate, timely flow of information by completing thorough patient records and updating healthcare team on patient status.
  • Collected specimens, monitored vitals and maximized patient comfort to maintain optimal environment.
  • Fostered relationships with patients, caregivers and healthcare teams to achieve individual care plan targets.
  • Used mobility devices to transport patients.
  • Delivered personal nursing assistance in pre- and post-operative situations.
  • Provided basic patient care by bathing and grooming patients, changing bedding and assisting in feeding activities.
  • Collected and documented vital signs to track current patient conditions.
  • Recognized and reported abnormalities or changes in patients' health status to nursing staff for immediate assessment.
  • Took patients vitals, including blood pressure, temperature and pulse and documented vital signs and weight of patients.
  • Engaged with patient family and friends to provide courteous visit experience.
  • Answered signal lights, bells and requests-for-service to assist patient services fulfillment.
  • Delivered high level of care to every patient.
  • Comforted patients and provided each with reassurance and encouragement.
  • Assessed vitals and noted medical information to report changes to nursing staff and physicians.
  • Turned or re-positioned bedridden patients to promote blood flow and prevent bedsores.
Education and Training
Expected in 06/1993 High School Diploma | Grayson County High School, Leitchfield, KY GPA:
Expected in Certified Nursing Assistant | Science, Technology, And Society Elizabethtown Community And Technical College, Elizabethtown, KY GPA:
Expected in 03/2010 Certified Nursing Assistant | Science Education Elizabethtown Community And Technical College, Elizabethtown, KY GPA:

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School Attended

  • Grayson County High School
  • Elizabethtown Community And Technical College
  • Elizabethtown Community And Technical College

Job Titles Held:

  • Prior Authorization Specialist
  • Discharge Receptionist
  • Unit Secretary
  • Certified Nursing Assistant


  • High School Diploma
  • Certified Nursing Assistant
  • Certified Nursing Assistant

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