Jaclyn Richards
Crete,IL
Summary
Experienced professional seeking a position that utilizes strong organizational skills, educational background, and effective collaboration abilities. Detail-oriented team player with a proven track record of multitasking and maintaining accuracy while managing multiple projects simultaneously.
Overview
26
26
years of professional experience
Work History
Founder
LH Senior Advocacy for Health NFC
2024.01 - Current
- Nonprofit Organization advocating for Seniors Providing resources, training, and support to caregivers and their families as they care for a Senior with a long-term care illness.
PPO/Provider/Pharmacy Claim Supervisor
Health Comp
2015.03 - 2024.01
- Responsible for overseeing the PPO/Provider Department as well as the Pharmacy Implementation/Claims Department Plan the daily work schedule for departments Set goals and performance deadlines to comply with the company’s vision Monitor employee productivity and provide constructive feedback and coaching Fill in for departments as necessary Assist in setting up Pharmacy Implementation for various PBM’s obtaining benefits and account structures
- Assisting team with Balancing and Processing Pharmacy Invoices
- Assist with EDI functions and files.
Insurance Review Specialist
Community Care Network
2014.08 - 2015.03
- Responsible for Identifying and Correcting Data errors Perform Claims Processing Tasks Track Claim Status, manage denials, initiate re-opening and appeals Responsible for performing customer service, self-pay follow-up, and bad debt management processes
- Responsible for maintaining an assigned work queue Responsible for assisting patients and practice staff with payment questions
Patient Service Representative
Franciscan Physicians Network Medical Arts
2013.08 - 2014.08
- Responsible for patient registration and appointment scheduling in the Epic system Responsible for Phone Support and Communication, Patient check-in and check-out, updating demographics and insurance information Responsible for collecting co-payments and past due balances, as well as processing daily bank deposit Responsible for assisting with paperwork and completing forms Responsible for general office duties such as mail, copying, filing, mailing, and faxing
Dental Office Assistant
School House Dental Services
2008.08 - 2013.07
- Responsible for assisting with a school-based dental program Responsible for submitting data received from the school program to the state Responsible for making appointments and discussing payment options with patients Responsible for insurance, billing, claims, and collections at the dental practice Responsible for setting up Softdent dental practice management software
General Liability Claims Adjuster
CCMSI
2006.10 - 2008.06
- Responsible for handling General Liability Property and Bodily Injury Claims, First Party Medical Claims, and Auto and Property Damage Claims for a Third-Party Administrator Experience with settling and negotiating Experience in handling a heavy volume of claims
- Examined claims forms and other records to determine insurance coverage.
- Prepared summaries of damage, payments, and policy coverage.
- Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
- Verified insurance claims and determined a fair amount for settlement.
- Documented all investigation activity and presented reports to management.
Bodily Injury Claims Adjuster
Affirmative Insurance Company
2001.05 - 2006.10
- Responsible for evaluating, negotiating, and settling auto injury claims Experience in handling heavy volumes of claims Experience with settling and evaluating auto property damage claims Experience handling and settling low-impact injury claims utilizing a bio-mechanical injury mechanism program
- Experience with ICD-9 codes and CPT codes Handled Medical Payments Claims
- Evaluated coverage, liability, and damages and investigated suspicious claims.
Licensed Sales Assistant
State Farm Insurance Agency
1999.11 - 2001.05
- Sold all lines of insurance / received my producer license to sell insurance Responsible for managing the office and helping policyholders with insurance needs Enthusiastic and assertive sales professional with 2 years of successful sales experience Able to design, develop, and implement professional presentations to clients and efficiently manage projects independently
Lead Clerk Receptionist
Primary Healthcare Associates
1998.06 - 1999.11
- Assisted Patients with appointments, verifying insurance Responsible for scheduling hospital procedures for patients Responsible for the front desk's day handling
- Provided quality clerical support through data entry, document management, email correspondence, and overseeing the operation of office equipment.
Education
Bachelor of Science in Healthcare Administration/Health Management -
University of Phoenix Online
Phoenix, AZ09.2013
Associate of Arts Degree in Healthcare Administration -
University of Phoenix
Phoenix, AZ05.2012
Skills
- Organizational Structuring
- Strategic Planning
- Succession Planning
- Consulting
- Staff Management
- Business Administration
- Financial Management
- Team Engagement
- Industry Expertise
- Recruitment and hiring
- Policies and Procedures Development
- Negotiation
- Business Development
References
References are available upon request.
Timeline
Founder
LH Senior Advocacy for Health NFC
2024.01 - Current
PPO/Provider/Pharmacy Claim Supervisor
Health Comp
2015.03 - 2024.01
Insurance Review Specialist
Community Care Network
2014.08 - 2015.03
Patient Service Representative
Franciscan Physicians Network Medical Arts
2013.08 - 2014.08
Dental Office Assistant
School House Dental Services
2008.08 - 2013.07
General Liability Claims Adjuster
CCMSI
2006.10 - 2008.06
Bodily Injury Claims Adjuster
Affirmative Insurance Company
2001.05 - 2006.10
Licensed Sales Assistant
State Farm Insurance Agency
1999.11 - 2001.05
Lead Clerk Receptionist
Primary Healthcare Associates
1998.06 - 1999.11
Bachelor of Science in Healthcare Administration/Health Management -
University of Phoenix Online
Associate of Arts Degree in Healthcare Administration -
University of Phoenix
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