Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary
Customer service-oriented professional with extensive experience in the healthcare industry. Technically proficient in Microsoft Word, Excel and PowerPoint. Skilled at medical billing, coding and office management. Excellent communicator with strong team-working and multi-tasking skills, successfully completes projects within time & budget constraints. Looking to relocate.
Professional Experience
10/2015 to Current Suspended Billing Representative Cvs Health | Indianapolis, IN,
  • Performs follow-up on outstanding Certificates of Medical Necessity (CMNs), prescriptions and processes renewal CMNs/prescriptions through the use of suspended billing reports.
  • Maintains and monitors follow-up system to confirm that action takes place per Apria "best practices." Performs timely follow-up on renewal authorizations to maintain reimbursement activity.
  • Contacts patient to gain involvement in problematic situations.
  • Elevates aged prescriptions to manager for decision and resolution.
  • Evaluates all completed CMNs/prescriptions/authorizations to ensure that the appropriate information has been obtained to allow for reimbursement as well as compliance with applicable standards and regulations.
  • Enters CMNs/prescription information into computer once the prescriptions are completed and returned from the physicians.
  • Documents all account activity on system.
  • May perform internal quality audits to ensure that all necessary documentation is included in each patient file.
  • Processes, reviews and mails prescription and/or CMNs to physicians for signature.
  • Researches diagnosis and insurance benefits to receive proper reimbursement.
  • Assists in obtaining authorization for reimbursement for some accounts.
04/2013 to 10/2015 Customer Service Specialist First Financial Bankshares | Grapevine, TX,
  • Responded to telephone, fax and EDI inquiries and orders from referral sources and homecare patients.
  • Documented referral request for coordination of care.
  • Provided information on equipment supplies and services.
  • Assisted patients/ referrals with the selection of equipment, supplies and services.
  • Demonstrated professional etiquette and courtesy when interfacing with customers.
  • Resolved patient/customer complaints by identifying problems and coordinating appropriate corrective action.
  • Assessed patient needs and promotes company products and services.
  • Complied with all regulatory compliance areas, policies and procedures and "best practices."
06/2009 to 04/2013 Team Lead - Manufacturing Grifols Inc. | Penn Hills, PA,
  • Developed production tracking and quality control systems, analyzing production, quality control, maintenance and other operational reports, to detect production problems.
  • Actively suggested operational improvements to enhance quality, improve production times and reduce costs.
  • Monitored and adjusted production processes or equipment for quality and productivity.
  • Helped achieve company goals by supporting production workers.
  • Performed product quality inspections.
01/2008 to 06/2008 Case Worker/ Mentor Overcoming Services | City, STATE,
  • Provided mentoring/tutoring services for registered teen offenders.
  • Administered hair follicle and urine drug testing for DCS and contracted businesses seeking pre-employment screening.
10/2001 to 02/2008 Office Manager - Customer Service Preventative Family Healthcare | City, STATE,
  • Created annual goals, objectives and budget and made recommendations to reduce costs.  
  • Implemented changes to existing methods to increase the accuracy, efficiency and responsiveness of the business.
  • Created processes and systems for increased business efficiency and customer satisfaction.
  • Generated sales and inventory reports in Excel with data from a variety of sources.
  • Interacted with customers and retail buyers.
  • Attended local, regional and national trade shows for product development training needs.

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    Job Titles Held:

    • Suspended Billing Representative
    • Customer Service Specialist
    • Team Lead - Manufacturing
    • Case Worker/ Mentor
    • Office Manager - Customer Service


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