Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary
Highly accomplished medical professional with a diverse background in medical staff management, medical and business office management/administration, and insurance authorization. Proven problem-solving, analytical, and creative thinking skills in a complex environment.
  • Type 50+ WPM
  • Electric Medical Records
  • 20+ years working in healthcare which includes 6 in Oncology

  • Project management
  • Analytical thinker
  • Quality improvement competency
Work History
02/2014 to Current Provider Network Manager Anthem, Inc. | Russellville, AR,
  • Responsible for provider contracting and maintaining positive working relationships with all participating providers and payers.
  • Serve as a liaison between the provider, payer and NCH's internal departments to address and resolve issues. 
  • Responsible for conducting provider in-services and educating network providers and supporting office staff on the process and policies of NCH. Provide ongoing support to the staff and providers. 
  • Meet with groups quarterly either in person or virtually to go over the data and discuss any needs from the group.    
  • Constant communication with payer representatives and help with member transitioning. 
  • Help implement new markets by working with payers in targeting groups, reaching out to the providers, setting up provider meetings and conducting training to the staff.

04/2012 to 01/2013 Prior Authorization Lead Hackensack University Medical Center | Belle Mead, NJ,
  • Oversaw the chemotherapy authorization department  and obtain prior authorizations. 
  • Managed and trained the staff.  
  • Supported the Claims and Denials departments to ensure all authorizations were obtained and no claim denials for "no auth".  

11/2011 to 03/2012 Prior Authorization Supervisor Nevada Cancer Center | City, STATE,
  • Obtained prior authorizations for chemotherapy services. 
  • Worked with various insurance companies to verify and obtain authorizations on a daily basis.  

07/2010 to Current Specialist, Prior Authorization/ Supervisor NEVADA CANCER INSTITUTE | City, STATE,
  • Worked collaboratively with clinical areas to ensure prompt prior authorization and insurance/benefit verification for oncology-specific services, procedures and treatments.
  • Specialized in obtaining STAT authorizations.
  • Developed key relationships internally and externally with insurance agents to ensure fast turn-around times.
  • Back up front desk personnel.
  • All aspects of Medical Records.
  • Audit prior authorizations for department personnel.

07/2008 to 2010 Residency Coordinator UNIVERSITY OF NEVADA SCHOOL OF MEDICINE | City, STATE,
  • Ensured appropriate orientation and education to 3rd and 4th year residents, and maintained daily operates within department.
  • Set up appropriately lectures and schedules.
  • Maintained department operational functions, including assisting where necessary, managing calendars, and maintenance of faculty credentialing files.

Expected in 1995 Diploma | Medical Office Management SAWYER BUSINESS COLLEGE, SACRAMENTO, CA GPA:
  • Coursework in Healthcare Administration
  • Coursework in Health Services Administration and Business

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  • Provider Network Manager
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