Open To Work
Jamie Grace
Help at Home Services-Part-time
Pittsburgh,PA
Work Preference
Job Search Status:
Open to work
Desired start date:
2 weeks notice
Desired Job Title
Remote Client Engagement SpecialistBehavioral HealthCase Manager-ContractedBehavioral HealthManager
Location Preference
RemoteHybrid
Location:
Pittsburgh, PA, US
Open to relocation:
Yes
6
Years of experience
Detail-oriented professional with extensive experience in customer service, compliance, and healthcare services. Skilled in managing large caseloads and supporting administrative functions. Proven ability to enhance member services and streamline operations, contributing to organizational efficiency.
Work History
Remote Client Engagement Specialist
6 Months- Managed inbound and outbound communications for large call centers, coordinating multiple campaigns and projects simultaneously.
- Manage ongoing Inbound and outbound for large call centers and handling multiple campaigns, multi-tasking, multiple projects.
- Microsoft Team Trainings and communication with teams consistently for large workloads.
- Contributed to special projects to enhance operational efficiency. as requested and meeting daily KPI metrics.
Behavioral Health
2 Years 2 Months- Provided direct care and support for individuals with daily living activities, implemented individualized care plans tailored to specific needs and goals.
- Ensured safety and well-being of individuals with disabilities through vigilant monitoring and proactive intervention.
- Administered medication, documented changes in client progress and behaviors, and maintained accurate medical records.
- Promote socialization, independence, and quality of life.
- Engaged in part-time position to assist clients
Case Manager-Contracted
4 Months- Facilitated case management and healthcare continuum, advocating for and enhancing patient experience throughout their journey.
- Assess physician needs and develop action plans that proactively mitigate delays in therapy or healthcare conditions.
- Assisted with benefit investigations and coordinated care to resolve patient and physician concerns, securing insurance approvals for therapies to prevent coverage delays.
- Coordinated case management for timely resolution and compliance with pharmaceutical needs, patient services, and authorization requirements.
- Collaborate and support consistent communication with internal and external partners (Pharmaceutical Reps, doctor offices, insurance companies, and patients).
Behavioral Health
3 Years 5 Months- Providing direct care and support to individuals with disabilities with daily living activities, implementing individualized care plans based on specific needs and goals of disabilities, maintaining medical records for accuracy, ensuring safety and well-being of those with disabilities, administering medication, documenting any changes in client progress and behaviors.
- Part-time
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
Manager
9 Months- Managed projects and conducted compliance reviews while organizing small business skills and providing career advancement services and assistance with applications and forms.
- Assisting businesses with contracts and business plans
- Assisted Veterans with financial services, appeals and grievances, questions, and concerns regarding forms.
- Accounts services, financial services, and resolved billing issues
- Guided Veterans through financial services and resolved inquiries regarding forms.
- Facilitated notarization of essential paperwork for clients., staff training, and coordinator services
Remote Claim Specialist
6 Months- Analyzed healthcare data, billing, patient denials, coordination of benefits, coding, insurance verification, and claims resolution to ensure accurate processing of claims.
- Analyze healthcare data, billing, data entry, patient denials, reviewed coordination of benefits, coding review, medical and insurance verification, revenue recycling, claims resolution, managed review, healthcare claim forms, and insurance review.
- Resolved billing and financial issues while ensuring compliance with HIPAA laws and guidelines to protect patient privacy.
Remote Compliance Specialist
8 Months- Managed disputes for grievances and appeals, processed denied and approved medical cases.
- Reviewed negotiations, support reviews, decided eligibility, presented employer contributions, supported and implemented retirement ERISA and compliance plans, approved EOB's, reviewed negotiations, reviewed additional documents for internal support review, monitored plan operations, assigned many plans for review for testing, billing, contributions, and added compensations plans for 5500 forms. Managed vendor reports, totals, and created action and statement letters.
- Managed client accounts, ensuring adherence to benefit plans and compliance requirements.
- Implemented process improvements that enhanced client onboarding experiences and reduced turnaround times.
- Developed training materials for new team members, improving knowledge retention and service delivery.
Teacher/Business and Technology
5 Months- Taught asynchronous and synchronous courses using audio and visual methods in career development, business, and marketing.
- Established learning systems and developed expertise in learning platforms including Blackboard and Canvas.
- Established efficient systems for learning management and tracking student progress., development, knowledge of learning platforms including Blackboard and Canvas for learning.
- Administered assessments to maintain educational credentials and integrated technology into classroom activities.
Education
Master's degree - business and healthcare management
GPA: High Honors
Bachelor of Liberal Arts and Science - Communications
Skills
Remote Communication Tools
Clinical Assessment Skills
Virtual communication
Insurance Claims
Quality Assurance
KPI Metrics
EPIC Systems & EMR Management
CMS certification
CRM and CMS
Data Entry
Microsoft Office Suite
Staff training & coaching
Workers' compensation experience
AWD and Relias Systems
Prior Experience in Workers’ Compensation
SUMMARY OF PROFESSIONALISM
- Improving work strategies
- Problem Solving
- Skilled in working, In-Office and Remote Settings
- Productive in meeting Guidelines
- Critical Thinking Skills
- Conflict Resolution Skills
- Leadership Skills
- Adaptable to change in the work environment
Timeline
Remote Client Engagement Specialist
AppleOne Inc. (Contracting)
02.2026 - CurrentRead More
Case Manager-Contracted
SSI People Company
09.2025 - 01.2026Read More
Behavioral Health
Help at Home Services-Part-time
06.2024 - CurrentRead More
Remote Claim Specialist
Elevated Patient Financial Services
06.2022 - 12.2022Read More
Manager
Main Professional Services
04.2022 - 01.2023Read More
Remote Compliance Specialist
National Benefit Services
10.2021 - 06.2022Read More
Teacher/Business and Technology
Roanoke City Public Schools
08.2020 - 01.2021Read More
Behavioral Health
Consumer Direct Services-Part-time
03.2020 - 08.2023Read More
University of Pittsburgh
Bachelor of Liberal Arts and Science from Communications
Read More
Strayer University
Master's degree from business and healthcare management
Read More