Remote-Opportunities Handler with MBA and Diverse Healthcare/Claims

*****.********@*****.***

jamie grace

(MBA)

Profile

I am a professional with friendly demeanor skills in several areas such as Healthcare Management, Communications, Case Management, Social Services, Insurance, Media Relations, Compliance, Worker’s Compensation, Claims, Settlement and Negotiations, and Teaching. A leader that is organized, an excellent listener, team-player, attentive to detail, multi-tasking, addressing conflicts, adaptable to change, and providing an impact to the establishment for continued success of the organization.

summary of Professionalism

WORK EXPERIENCE

●Client Success/Case Manager

●Project Management

●Client Engage Specialist

●Excellent Customer Service

●Excellent Listening Skills

●Productive in meeting deadlines

●Excellent Writing Skills

●Friendly and Courteous in the workplace

●Leadership and Training

●Punctual

●Problem Solving

●Critical Thinking Skills

●Skilled in High Volume Workloads

●Skilled in High Volume Calls and Monitoring

●Zoom and Chat Skills

Apple One-Shareholder Engagement Specialist Remote, PA

Present

●Notifying Shareholders of events or changes evolving on their stocks.

●Handling inbound and outbound calls

●Multi-tasking with calls, trainings, and Microsoft Teams

●Answering concerns and consistency in messaging

●Customer Service and Call Center Responsibilities

Contractor-Case Manager

SSI People Company contracted to ConnectiveRx Robinson, PA 9/2025-1/2026

●Provided primary duty is to assist customers with chronic illness in their assigned territory by accessing their well-being needs, journey, and treatment plan.

●Collaborate and support consistent communication with internal and external partners (Pharma Reps, Doctor offices, or insurance companies).

●Case coordination tor prompt case resolution and maintain compliance based on matters of significance.

●Facilitate case management and process healthcare continuum, advocate and contribute to patient positive journey.

●Assess Physicians needs and develop action plans that proactively mitigate delays in therapy.

●Effectively manages the database, including data on each individual, their insurance, coverage approvals, ongoing coverage requirements, and all patient and provider interactions.

●Support special projects as requested.

●Assist Benefit Investigation as needed, utilize care coordination to address patient and physician concerns and obtain insurance approval for designated therapy and proactive plans to avoid the potential of delayed coverage by working with patient, family, insurance, company, physicians, workplace, benefit administrators, and individual from other areas.

Direct Care Services/IDD Services

Moravia and Help at Home Pittsburgh, PA

10/2023-2025

●Provided direct care and support to individuals with daily living activities, implement individualized care plans based on specific needs and goals disabilities, ensuring their safety well-being, promote socialization and independence, and quality of life, administered medications according to prescribed schedules and documented any changes or reactions seen, and maintained accurate records of client progress, behaviors, incidents, and medication administration.

Direct Care Services

Consumer Direct Care Network of Virginia

3/20-8/23

●Specialized in helping adults with intellectual disabilities live in the home with direct care services, supported home care services for those with disabilities

Remote Health Claim Specialist

Elevated Patient Financial Services

6/22-12/22

●Analyzed healthcare Data, patient denials, review of Coordination of Benefits, Coding Review, Insurance and medical verification, revenue recycle managed review, Healthcare claim forms and insurance review.

●CMS approved for Medicare and Medicaid Systems/UB Forms, knowledge of policies and procedures as it relates to grievances and appeals.

●Ensured medical claims were processed accurately,timely managed multiple high-volume calls by phone, chat and emails regarding high volume claims, in processing, denying services and appeals appropriately, medical billing and insurance follow-up for providers, hospitals and clients, responsible for reviewing and supporting the highest degree of patient privacy and all other HIPAA related laws, responsible for data governance, and consistently meeting or exceeding performance metrics for response time and customer satisfaction.

●Troubleshooting technical issues faced by remote customers, resulting in reduction in escalations to higher-level support teams, step-by-step guidance offered to customers on how to navigate online platforms or use software applications effectively.

●Resolved billing and collection discrepancies for patients by investigating account details and coordinating with the finance department for prompt resolution.

●Maintained up-to-date knowledge of company products/services as well as industry trends to provide correct information and recommendations remotely.

●Found patterns or recurring issues reported by customers and proactively communicated them to the appropriate departments for process improvement initiatives, and effectively managed dissatisfied patients by actively listening to their concerns, empathizing with their frustrations, and finding suitable solutions that exceeded expectations whenever possible.

Remote Compliance Specialist

National Benefit Services

10/21-6/22

●Data Entry Dispute Review/Compliance, Case Entry Review, Grievances, Appeals and Dispute for Medical Cases, ensured medical disputes were processed, and approved on time for EOB’s, Itemized statement and invoice review, review of negotiations and additional documents internal support review, and deciding eligibility, and supported relationship managers in preparing, calculating, and presenting employer contributions, supported implement team in retirement ERISA compliance plans, CMS certified/federal IDR access, CMS Review of Invoice, and fees for disputes, assigned many plans for review report, billing, contributions, testing, and any added review of compensations plans, 5500 forms. downloading vendor reports, importing files, reviewing statement reports, for totals, creating action and statement letters.

●Monitor of plan operation and adherence to terms, rules, and regulations and perform other duties as assigned by Supervisor and Vice President.

Teacher

Roanoke City of Public School -Business and Technology

2/20-1/21

●Skilled in classroom teaching for middle school students with and without special disabilities for Career Development, Business and Marketing.

●Asynchronous and Synchronous Learning through audio and visual, which entailed creating curriculums, Set-up systems for learning and development and knowledge of various learning platforms, such as Blackboard & Canvas.

●Created lesson plans and all curriculum for each class.

●Worked with Students with IEP’s and 504 Plans

●Administered tests to keep educational credentials up-to-date, created and incorporated technology in the classroom setting.

key skills and attributes

●Proficient in Microsoft Office Suite, Outlook, Word, Excel, Powerpoint

●MIcrosoft Teams

●ODP /IDD Training Certificate

●CRM

●Windows Based Systems

●Sales Force/Five 9

●Care Central

●EPIC Systems

●Data Entry/Analyst

●Administrative Services

●Healthcare System Services

●Staff training & coaching

●Quality assurance

●CMS Portal Certified

●Ring Central Systems, Citrix Systems, MPower

●GTD Splash, AWD Systems and Relius

●EDI and Availity Systems

●Medical Billing and Coding compliance

●Media Relations

●Intake, Enrollment, and Patient Support Services

●Account Services

●Teaching

education

High Honors

Master’s degree in business management and healthcare

Strayer University

Graduated 12/2007

Bachelor’s degree in liberal arts and communication

University of Pittsburgh

Graduated 4/2000

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