Jacqueline Carrasco
Joshua,TX
Summary
Accomplished and highly analytical professional with a diverse background with demonstrated success in navigating complex healthcare and legal environments. Seeking a long-term opportunity with an organization that values integrity, innovation, and professional development. Committed to leveraging a broad range of transferable skills, industry knowledge, and analytical expertise to contribute to organizational growth while continuing to expand my professional capabilities and advance into increasingly impactful leadership roles.
Overview
11
11
years of professional experience
Work History
Operations Specialist
One Call
Remote
01.2023 - Current
- Supported the initial credentialing and recredentialing of healthcare providers, ensuring required documentation was obtained, reviewed, verified, and maintained.
- Assisted with resolving credentialing discrepancies and incomplete applications while maintaining accurate provider files.
- Conducted provider credentialing and recredentialing activities, including review and verification of licenses, education, training, certifications, work history, malpractice coverage, and other provider qualifications.
- Monitored cases for compliance with regulatory and internal turnaround-time requirements, escalating complex or time-sensitive issues when necessary.
- Tracked grievance and appeal cases to ensure completion within established CMS, state, contractual, and organizational timeframes.
- Investigated and processed member grievances and appeals by reviewing case documentation, claims information, medical records, policies, and applicable benefit requirements.
Pre-Litigation Case Manager
Bailey & Galyen Law Firm
Bedford, Texas
04.2018 - 12.2022
- Serve as the primary point of contact for clients, providing consistent communication, case updates, and guidance throughout the pre-litigation process.
- Obtain and review medical records, itemized billing statements, diagnostic reports, treatment plans, and physician documentation.
- Communicated regularly with clients to provide case updates, gather information and address inquiries.
- Manage a high-volume caseload from client intake through settlement while ensuring all legal deadlines and procedural requirements are met.
- Communicate regularly with healthcare providers to obtain records, billing information, and treatment updates.
- Analyze medical expenses, future treatment recommendations, lost wages, and other damages to assist in case valuation.
- Negotiate directly with insurance adjusters regarding settlement offers, medical expenses, liability disputes, and claim resolution.
- Ensure compliance with firm policies, legal regulations, confidentiality requirements, and HIPAA standards.
- Investigate liability by reviewing police reports, accident reports, photographs, medical records, witness statements, insurance policies, and other relevant evidence.
Receptionist
Bailey & Galyen Law Firm
Bedford, TX
02.2016 - 04.2018
- Scheduled appointments, ensuring efficient utilization of attorneys' time.
- Managed incoming calls and directed inquiries to appropriate staff members.
- Prepared outgoing mail including packages, certified letters, and courier services.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Utilized case management software to track case progress and deadlines.
- Processed Client transactions efficiently.
Education
GED -
Ged.Com
Online06-2015
Certified Professional Coder (CPC) - Medical Coding
AAPC
Online08-2026
Skills
- Regulatory Compliance
- NCQA Credentialing Standards
- CMS Regulatory Requirements
- State Healthcare Regulations
- License & Certification Verification
- Provider Enrollment & Maintenance
- Cross-Functional Collaboration
- Confidentiality & HIPAA Compliance
- High-Volume Case Management
- Attention to Detail & Accuracy
- Database & Healthcare Systems
- Written & Verbal Communication
- Underpayment Recovery
- Client Intake
- Case Documentation
- Settlement Coordination
- Pre-Litigation Case Management
Timeline
Operations Specialist
One Call
01.2023 - Current
Pre-Litigation Case Manager
Bailey & Galyen Law Firm
04.2018 - 12.2022
Receptionist
Bailey & Galyen Law Firm
02.2016 - 04.2018
GED -
Ged.Com
Certified Professional Coder (CPC) - Medical Coding
AAPC