Reimbursement Consultant resume example with 20+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
Executive Profile
Thirty years of administrative experience in small and large health care settings, combining decision-making with a professional attitude. Possess strong interpersonal communication skills resulting in a high degree of client satisfaction.
Skill Highlights
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Core Accomplishments
Professional Experience
Reimbursement Consultant, 09/2009 - Present
Banner Health Phoenix, AZ,
  • Prepare parts of written reports to clients.
  • Perform Medicaid Audits for Graduate Medical Education.
  • Work on the proposal writing teams, including writing sections, coordinating efforts, and preparing proposal submissions.
  • Assess best practices and compliance errors and provide technical assistance to a wide variety of stakeholder and clients.
  • Submit appeals for audited cost reports and request reopening of filed cost reports as needed in order to obtain reimbursement maximization.
  • Recovered $2,500,000 in Bad Debts underpayments for fiscal year 2011 for DHH Behavior Health Hospitals.
  • Recovered $40,000,000 in DSH underpayments for fiscal year 2010 for the DHH Behavior Health Hospitals.
  • Recovered 50,000,000 in DSH underpayments for fiscal year 2013 DSH Audit Examination for DHH Behavior Health Hospitals.
System Internal Auditor, 08/2007 - 09/2009
Marshfield Clinic Medford, WI,
  • Responsible for the planning and performance of scheduled audits, follow-up audits, and special audits requests from Louisiana State University System.
  • Performs the inspection of cash controls records, Payroll records (Peoplesoft) and other selected financial activity as needed.
  • Work with outside fiscal intermediaries on Medicaid/Medicare Cost Audit Issues.
  • Perform Medicaid Audits for Graduate Medical Education.
  • Supervise the observation of the physical inventories of supplies and moveable property conducted by the hospital staff to fulfill the Louisiana Administrative Code requirements and financial statement requirements.
  • Participate in audits performed by external auditors, fiscal intermediaries, government oversight agencies and the Legislative Auditor's Office.
  • Perform the examination of financial statements (General Ledger System), reconciliation's journals and other financial transactions for executive management.
  • Assist in preparation of materials for training seminars administered by the agency.
  • Conduct extensive policy and procedures research.
  • Assist in the preparation of draft reports and documentations for System Audit Committee's.
Corporate Director, 01/2007 - 07/2007
Medical Management Options City, STATE,
  • Managed four subordinate supervisors who supervised a total of three to six employees in Payroll, Accounts Payable, Billing and Account Receivables.
  • Responsible for the overall direction, coordination, and evaluation of business units.
  • Carried out supervisory responsibilities in accordance with the organization's policies and applicable laws.
  • Interviewed, hired and trained employees: planning, assigning, and directing work; appraising performance; rewarding and discipline employees; addressing complaints and resolving problems.
  • Directed preparation of budgets, collections, and prepared necessary supporting documentation and justification.
  • Generated all billing and reimbursements projections using Excel and Great Plains software.
  • Prepared reports required by regulatory agencies.
Reimbursement Auditor, 01/1999 - 01/2007
Blue Cross/Blue Shield Of MS Dba Tri Span Health Services City, STATE,
  • Train, evaluate, oversee, and direct audit team activities.
  • Posses advanced organization and time management skills to conduct multiple projects and deadlines.
  • Posses a detailed knowledge of Medicare/ Medicaid Reimbursement regulations, guidelines, procedures, bulletins, interpretations, and has the expertise to apply the knowledge in conjunction with generally accepted accounting and auditing procedures.
  • Prepare parts of Medicaid Cost Reports for Critical Care Hospitals, Teaching Hospitals, Rural Health Clinics, and Mental Health Clinics.
  • Supervise the field auditors.
  • Use advanced technology to process financial transactions and analyze results for regulated and non- regulated business.
  • Provide financial and audits result and communicate findings to management and the Department of Health and Human Services.
  • Provide financial transaction and information delivery systems including standard reporting tools to the business and government units.
  • Provide analytical support for external audits and regulatory filings.
  • Special projects to develop new accounting policies/processes and analyze corporate performance.
MBA: , Expected in May 2005
University of Phoenix - , PA
: , Expected in 1996
Management Training Institute Louisiana State University - ,
Bachelor of Science: Business Accounting / Business Management, Expected in 1982
Southern University - ,
Business Accounting / Business Management
Professional Affiliations
National Association of Accountants, America Association or Internal Auditors, National MBA Association, Girls Scout of America, Alpha Kappa Alpha Sorority, Alumni Board President- Redemptorist High School, School Board Member -Redemptorist High School, Louisiana Department of Health and Hospitals Fiscal Task Force Member, Health Financial Management Association Member. 1
Tri-Span Health Services - Employee of the year 2001, 2002, 2003, 2005 Girl Scout Troop 952 - Volunteer of the year: 2000, 2002, 2003, 2004, 2005
accounting, Accounts Payable, Administrative, agency, auditing, Billing, budgets, Critical Care, clients, delivery, Department of Health, directing, direction, documentation, executive management, external audits, financial, financial and audits, financial statements, General Ledger, government, Great Plains software, inspection, materials, Mental Health, Excel, Office, Payroll, Peoplesoft, policies, processes, proposal writing, proposal, reporting, research, seminars, supervisory, Teaching, technical assistance, time management, written
Additional Information
  • AWARDS: Tri-Span Health Services - Employee of the year 2001, 2002, 2003, 2005 Girl Scout Troop 952 - Volunteer of the year: 2000, 2002, 2003, 2004, 2005

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Resume Overview

School Attended

  • University of Phoenix
  • Management Training Institute Louisiana State University
  • Southern University

Job Titles Held:

  • Reimbursement Consultant
  • System Internal Auditor
  • Corporate Director
  • Reimbursement Auditor


  • MBA
  • Bachelor of Science

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