J .James * of *

J A C Q U E L I N E J A M E S

Gainesville Florida 32607 Mobile: 407-***-**** Email: ad3xlw@r.postjobfree.com Summary: I consider myself a dedicated professional with extensive expertise in healthcare industries in the areas of but not limited to: Accounts Receivables/Billing, Collections, and Case Management. My strong communication and time management skills have contributed to my success in fast-paced healthcare environment. Fluent in both English and Spanish, and proficient in software tools like Word, Outlook, and Excel, I excel in diverse settings. With a history of optimizing revenue, resolving outstanding balances, and maintaining high-quality customer service, I am a valuable asset in any organization. I am local and available for interviews within prior notice.

Education:

• High School Diploma

John F. Kennedy High School Bronx 1981

• Completed 42 credit hours towards Child Psychology Farleigh Dickinson University Teaneck, NJ 1982

Skills:

• Accounts Receivables/Billing

• Collections

• Patient Benefits Advisor/Coordinator

• Case Worker/Manager

• Effective Communication

• Customer Service

• Time Management

• Conflict Resolution

• Bilingual: English & Spanish

• Software Proficiency: Word, Outlook, Excel

• Highly Organized

• Works Well in a Team

• Committed to Data Integrity

• Detailed Oriented

Professional Experience

Vitas Healthcare Hospice May 2022 to Jul 2023

Case Worker Medical Billing Medicaid Specialist

• Managed accounts receivable by efficiently collecting payments from Medicaid /insurance providers.

• Implemented effective research strategies, resulting in increased revenue and reduced outstanding balances for Medicaid excel monthly spread for cooperate management.

• Conducted professional and persistent collections calls with DCF to resolve further documentations on Medicaid recipient accounts while maintaining a high level of customer service for various nursing home facilities.

• Assist in the screening process with patient care givers for Hospice Medicaid application by following the DCF criteria.

• Liaison between Vitas cooperate office located in Miami FL, referring patient care givers to various Elders attorney office in both citrus & Alachua Counties for Nursing Home Facilities, and DCF.

• Capacity to work with minimal Supervision. Ability to become proficient on companies’ software programs.

• Extensive knowledge of community resources within the specific counties for both programs 78 & 79 in which the hospice is located.

• Knowledge of local, county, applicable state and federal assistance programs. J .James 2 of 3

Appriohealth aka Candide Orlando, FL Oct 2018 to May 2022 Medical Billing & Patient Advocate Medicaid Specialist

• Revise and manage all Florida state assistance programs and hospital charity applications for eligibility determination.

• Assess patient’s financial requirements and evaluated patients for existing Medicaid criteria.

• Conduct case management interviews and served as a liaison between hospitals and various governmental agencies.

• Evaluate eligibility screening for potential Medicaid participants for all Florida Hospitals in the Central, and Northern FL regions.

Heart of Florida United Way Orlando, FL Aug 2017 to 2018 EHS Technician/Case Worker

• Interviewed clients and assessed their situations to determine what services were required to meet their needs.

• Maintained case history records, and prepared clients’ applications for Auditing.

• Submitted applications and reviewed reports or problems with Finance Department Audits standards.

• Advised clients regarding food stamps, childcare, food, money management, sanitation, or housekeeping.

• Assist clients with preparation of forms, such as applications, and collected supplementary documentation.

• Provided, found, or arranged for support services, such as housing, childcare, prenatal care, substance abuse treatment, job training, counselling, or parenting classes to prevent more serious problems from developing.

HCA Parallon Casselberry, FL Jul 2013 to 2017

Patient Benefits Advisor/Medicaid Eligibility advocate

• Conducted eligibility screening for potential Medicaid participants for all Orlando Hospitals in the Central FL.

• Performed case management, and served as a liaison between hospitals, and various governmental agencies.

• Assessed patient’s financial requirements and evaluated patients for existing insurance coverage.

• Reviewed/process all State assistance programs, and hospital charity applications for eligibility determination w DCF.

J .James 3 of 3

Quest Diagnostics /Ameri Path Orlando, FL Jun 2012 to 2013 Collections Coordinator Billing Department

• Collected on Payers accounts and performed reviews of accounts that were denied or in the appeals process.

• Routed incoming calls to individuals or departments and followed-up on submitted claims. Axium/Health Care Pharmacy Lake Mary, FL Sep 2010 to 2012 Cash Unapplied Reimbursement Collector Specialist

• Accurately researched unapplied cash transactions for various government and commercial insurances.

• Reconciled Medicare ERA Reports versus daily deposits and investigated discrepancies and applied debits/credits.

• Reviewed and responded to all accounts receivables and assigned claim inquiries in a timely manner. Inverness/Quality Assured Services DME Maitland, FL Sep 2008 to 2010 Insurance-Benefits Case Coordinator

• Qualified patients for a aging of over 500 patients on a monthly basis on Follow up Collections, Billing, excel spread sheet.

• Submitted & Re-Billing on Durable Medical Equipment information (VAD) required to pre-determine to various Commercial and Governmental insurance carriers for processing.

• Built patients cases, for negotiation with various carriers and computed patients’ co-pays and deductible for collections processing.

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