Jessica Larner
Melbourne,FL
Summary
Driven and client centered professional, with high enrollment rates in member outreach programs by means of effective data analysis and problem-solving. Focused on enhancing efficiency of task management, while streamlining complex processes for Health First Health Plans members.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Senior Clinical Support Specialist
Health First Health Plans
Rockledge, FL
09.2024 - Current
- Export inpatient discharge data to an Excel spreadsheet using Microsoft Power BI.
- Export admission data for Medicare members for the Community Nurse Navigator Program using Microsoft Power BI, and create referrals within MHK.
- Review supplemental benefits over the phone with inpatient Medicare members.
- Export data pertaining to the ACT High-Risk OB and Postpartum Programs.
- Create ACT referrals within MHK and assign to case manager, assisting with member outreaches as needed.
- Contribute directly to the Transitions of Care team achieving a 90% member enrollment rate for the entirety of 2025.
- Facilitate provider follow-up for health plan members with a recent inpatient admission, exceeding the 75% goal for July 2025.
- Triage health plan members over the phone, often finding them eligible for Complex case management.
- Assign created Transitions of Care referrals to case managers based on severity and need.
- Record referral assignment numbers on an independently created Excel spreadsheet, submitting the spreadsheet to management at the end of the pay period.
- Regularly accept the entire caseload of health plan members who are eligible for the Diabetes Prevention Program, ranging from 10 to 30 members per month.
- Complete monthly phone contact with enrolled members, and complete an educational review on diet, weight management, and annual wellness visits.
- Consistently maintain a high enrollment rate in member outreach programs.
- Create teaching tools and desktops for distribution among the department, including, but not limited to, Amisys How to Guide, Manual Mail Process Guide, and Unassigned Bin How.
- Serve as the Associate Month of Giving Ambassador for 2025.
Clinical Support Specialist
Health First Health Plans
Rockledge, FL
11.2023 - 09.2024
- Exported inpatient discharge data to an Excel file using Microsoft Power BI
- Scrubbed data to display relevant information needed for the creation of Transitions of Care referrals.
- Perform chart reviews to determine the length of inpatient stay, admitting diagnosis, risk for readmission, and case management program involvement.
- Create transitions of care referrals inside MHK.
- Assign referrals to the appropriate RN case manager based on member needs.
- Conduct outbound phone calls to providers' offices to verify the status of a member's hospital follow-up appointment.
- Perform various clerical and administrative tasks at the request of case managers.
Customer Care Associate
Health First Health Plans
Rockledge, FL
03.2023 - 11.2023
- Investigate complicated claims issues, offering the appropriate solution/information to the caller.
- Create document supply requests and route to the appropriate department for member/provider delivery.
- Compile information to compose grievances for health plan members over the phone.
- Review and utilize multiple Excel spreadsheets for up-to-date provider information, check cashing statistics, wellness program inquiries, etc.
- Display empathy and compassion daily, while actively listening to and addressing member concerns.
- Recorded detailed notes of all customer interactions in an internal call logging system.
- De-escalated calls from distraught members on multiple occasions, preventing a transfer to leadership.
- Volunteer for and attend multiple activities outside of assigned daily duties, such as member benefit sessions, broker seminars, and Medicare member events.
Medical Receptionist
Coastal Mental Health Center
Palm Bay, FL
04.2019 - 01.2021
- Verified insurance coverage for appointments and collected co-payments as required.
- Scheduled patient appointments, verifying accuracy of appointment times with providers.
- Compiled and submitted prior authorization requests to up to 15 different insurance companies.
- Regularly review provider licensing and ensure they are renewed and displayed before expiration date.
- Composed monthly schedules based on availability and patient needs for multiple therapists across the organization.
- Adhered to strict HIPAA guidelines regarding patient information.
Customer Service Lead
Winn Dixie
Melbourne, FL
02.2013 - 04.2019
- Directed customer service staff activities, including training, coaching and performance management.
- Maintained accurate records of customer interactions and transactions.
- Resolved escalated issues from team members or customers in an efficient manner.
- Accounted for up to 20 cash drawers at a time, reconciling discrepancies as needed,
- Performed daily cash management activities including posting payments, transfers, deposits, and withdrawals.
- Conducted domestic and international wire transfers using third party software.
Education
MBA - Healthcare Management
Florida Institute of Technology
Melbourne, FL12-2026
Bachelor of Science - Healthcare Management
Eastern Florida State College
Cocoa, FL12.2019
Skills
- Documentation and Reporting
- Critical thinking
- Microsoft Power BI
- Data analysis
- Task delegation
- Regulatory compliance
- Clinical assessment
- Decision-making
Certification
- HIPAA Basics Training Department of Children and Families - 2019
- Functional Assessment Rating Scale Department of Children and Families - 2019
- Scientific Workplace Preparation Certificate Eastern Florida State College - 2017
References
References available upon request.
Timeline
Senior Clinical Support Specialist
Health First Health Plans
09.2024 - Current
Clinical Support Specialist
Health First Health Plans
11.2023 - 09.2024
Customer Care Associate
Health First Health Plans
03.2023 - 11.2023
Medical Receptionist
Coastal Mental Health Center
04.2019 - 01.2021
Customer Service Lead
Winn Dixie
02.2013 - 04.2019
MBA - Healthcare Management
Florida Institute of Technology
Bachelor of Science - Healthcare Management
Eastern Florida State College
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