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

Innovative, customer-oriented healthcare administrator with background in managed, ambulatory and long-term care. Strong background in quality assurance, claims analysis and management principles and practices. Seeking a leadership role within an integrated delivery system. Authorized to work in the US for any employer


Collections • Billing • Excel • Management • Medical Coding • Microsoft Excel • Data Entry • Sales Experience • Accounting • Operations Management • Typing • Insurance Verification • Healthcare Management • Medical Billing • Medical Collection • Customer Service • Account Reconciliation • Microsoft Office • Documentation review Additional Information Skills Prism, Epic, Nextgen, GPS, Nice System/COSMOS Microsoft Windows XP/ Emptoris/Typing (45+ wpm) Excel/Access DB/PhyCon Medicare/Medicaid/Commercial/ Hospital Claims

08/2021 to Current
Technical Denials Mgt Speclialist II /UT Southwestern City, STATE,

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  • Contract loading, meeting/exceeding quality standards, Intermediate to advanced skills in Microsoft Excel (V-lookups, pivot tables, sorting, filtering, analyzing and remediating data discrepancies).UT Southwestern is the pre-eminent hospital system in Texas and one of the leading medical facilities nationwide has an opening for a Technical Denials Management Specialist II within the Revenue Cycle Department team.

This position affords you the opportunity work from home (WFH) after all training has been completed. Once training is completed, you will need to be available to come into the office for future training, meetings, etc., as needed. Although this position is WFH, it is subject to the possibility of returning to campus at the discretion of UTSW.

Insurance experience is ideal; BC/BS, Aetna, Humana, etc. EPIC experience is preferred. This is a high volume position, accuracy and efficiency are a must.



High School Diploma; Associate’s degree preferred. Two (2) years’ experience in medical claims recovery and/or collections required

Job Duties:

  • Contacting payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and requests for additional information.
  • Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
  • Make necessary adjustments as required by plan reimbursement.
  • Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
  • Reviews, research and appeal partially denied claims for reconsideration.
  • Responsible for contacting patients to gain additional information required to resolve an outstanding insurance balance.
  • Functions as resource person for departmental personnel to answer questions and assists with problem resolution.
  • Performs other duties as assigned.


This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

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  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Verified policy holder data, including age, contact number and physical address.
  • Complied with confidentiality regulations in handling customer information.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Verified patients had proper insurance coverage prior to procedures or appointment scheduling.
  • Updated patient and insurance data and input changes into company's computer system.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
  • Composed business correspondences for supervisors, managers and other professionals.
  • Modified, updated and processed existing policies and claims to reflect changes in beneficiary, amount of coverage and type of insurance.
  • Processed claims for payment or forwarded to appropriate personnel for further investigation
  • Corresponded with insurance customers and agents to obtain or relay information on account status changes.
  • Precisely calculated refunds, premiums, and adjustments.
  • Handled modification and updating of policies.
  • Collaborated with fellow team members to manage large volume of claims.
  • Examined claims, records and procedures to grant approval of coverage.
  • Assisted new policyholders with processing claims.
01/2020 to 07/2021
Physicians Accounts Receivable Representative III Xtend Healthcare LLC City, STATE,
  • Effectively manages assigned insurance receivables to achieve business line expectations.
  • Exceeds a minimum of 85% work quality scoring and accuracy on all accounts worked.
  • Completes timely follow-up on assigned accounts to ensure no cash loss.
  • Exceeds monthly cash expectations as set out for assigned client receivables.
  • Ensures insurance accounts are resolved within 90 days of placement.
  • Demonstrates the ability to prioritize work with minimal oversight to meet outlined goals.
  • Acts as a knowledge resource for team members.
  • Perform account research and route accounts through appropriate client workflows.
  • High level understanding of client host system functions.
  • Clearly documents actions taken and next steps for account resolution in patient accounting system.
  • Excellent working knowledge of Prism system and displays clear understanding of claim updates, request workflow, and action step entry into the system.
  • Demonstrates advanced understanding of commercial and Medicaid payers.
  • Has knowledge of Medicare guidelines and is able to accurately perform corrections according to CMS guidelines.
  • Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions).
  • Compiles appeals and approves appeal requests for team related to technical payment denials.
  • Demonstrates the ability to act as request approver for team members to ensure accurate actions are taken for account resolution.
  • Reflects understanding of payer contract verbiage and the ability to negotiate payment utilizing contract terms.
  • Ensure strong communication skills to convey intricate account information.
  • Ensure all accounts are worked within client standards and Federal Regulations.
  • Maintain high quality account handling per client standards.
  • Work within federal, state regulations, department/division & all Compliance Policies.
  • Maintain clear, concise and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications.
09/2018 to 01/2020
Collections Representative II MEDNAX / Pediatrix Medical Group City, STATE,
  • Ensures claims are processed accurately to secure timely payment.
  • Responds to inquires, questions and concerns from patients regarding the status of claims in a clear, concise and courteous manner.
  • Conducts follow-up and suits reimbursement appeals for unpaid/or inappropriately paid claims, ensures appropriate documentation of billing, follow-up, collection, and appeal efforts are recorded on accounts.
  • Identifies, researches, and ensures timely processing of billing errors and corrections as they relate to claims: actively participates in problem identification and resolution and coordinates resolutions between appropriate parties.
01/2016 to 09/2018
R Representative Conifer Healthcare City, STATE,
  • Responsible for providing assistance, coaching and training to staff members, including new hires.
  • Support and assist the Team, the Supervisor and Management with complex inventory and issue resolution.
  • Responsible for all aspects of the billing, follow up and collection activity for payers that are Supplemental to Medi-Cal.
  • Responsible for all aspects of the billing, follow up and collection activity for payers that are Supplemental to Medicare.
  • Edit claims to meet and satisfy billing compliance guidelines for electronic submission.
  • Appeals/Tar appeals and C Ifs.
Education and Training
Expected in
Certificate in Medical Billing: Accounting
Claims American Career College - North Hollywood, CA
Expected in
High school diploma or GED:
Capella University - Minneapolis, MN

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School Attended

  • Claims American Career College
  • Capella University

Job Titles Held:

  • Technical Denials Mgt Speclialist II
  • Physicians Accounts Receivable Representative III
  • Collections Representative II
  • R Representative


  • Certificate in Medical Billing
  • High school diploma or GED

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