JESSICA MORALES
Beaverton,OR
Summary
Experienced healthcare operations professional with over 10 years in health plan administration and medical management. Skilled in clinical concurrent review, inpatient admissions coordination, and medical record processing. Expertise in Epic, Facets, and electronic health record systems enhances operational efficiency and compliance.
Overview
2027
2027
years of professional experience
Work History
Medical Management Technician Concurrent Review Department
PROVIDENCE HEALTH PLAN
12.2019 - Current
- Supported clinical concurrent review nurses and medical directors in inpatient case coordination, medical necessity review, and timely case processing to enhance overall workflow efficiency.
- Review, organize, and process medical records and admission information to facilitate clinical review and appropriate case routing.
- Coordinated provider and facility communications, managed time-sensitive admission requests, and scheduled peer-to-peer meetings to facilitate effective collaboration between providers and clinical staff.
- Support inpatient and skilled nursing facility (SNF) authorization workflows, ensuring required information is available and cases are routed to the appropriate team and line of business.
- Maintained admission and discharge tracking reports, compiled data in Excel for productivity monitoring, and contributed to departmental reporting accuracy.
- Use Epic, Facets, Microsoft Office, and secured electronic medical record systems to research, document, and process case information.
- Collaborate with clinical teams, providers, facilities, and internal departments to resolve issues, improve workflows, and maintain processing accuracy.
- Adapt to new systems, implementations, and expanded responsibilities while meeting productivity, confidentiality, and compliance expectations.
Public Programs Specialist
PROVIDENCE HEALTH PLAN
- Assisted Medicare and Medicaid members with benefits and eligibility questions, ensuring understanding of coverage, deductibles, and in-network and out-of-network services.
- Guided members in locating primary care providers, specialists, transportation resources, and other essential healthcare services to enhance access to care.
- Managed appeals and grievances, addressing member concerns and facilitating timely resolutions to improve member satisfaction.
- Delivered professional, compassionate service while handling confidential healthcare and benefits information.
Legal Account Specialist
PROVIDENCE HEALTH & SERVICES
- Managed high-value patient accounts, supporting Legal team in resolving outstanding medical balances and securing appropriate payments for services.
- Communicated with patients, attorneys, and representatives on third-party liability claims, medical balances, settlements, probate accounts, and medical liens to expedite resolution.
- Negotiated settlement arrangements and explored financial assistance options to help patients resolve medical debt.
- Maintained accurate account documentation while safeguarding confidential patient and financial information per organizational requirements.
Office Assistant II Legal Team
PROVIDENCE HEALTH & SERVICES
- Provided administrative support to attorneys and Legal Assistants handling patient information requests, high-value accounts, third-party liability, and Workers' Compensation matters.
- Processed, scanned, organized, and transmitted confidential patient records to ensure timely access for legal review.
- Prepared financial reports using Microsoft Excel and provided guidance to patients on MyChart Prompt Pay Discount options.
- Managed competing requests, ensuring accuracy and confidentiality while completing administrative tasks within deadlines.
Office Administrator
PRIDE STAFF
- Coordinated daily business operations through administrative support, enhancing customer service, data entry accuracy, and account maintenance.
- Facilitated accounts payable and receivable processes, ensuring accurate financial and client record management.
- Handled incoming calls, email correspondence, and vendor communications, fostering professional client relationships.
Contact Center Representative I
THE STANDARD / VOLT WORKFORCE SOLUTIONS
- Delivered customer service in a high-volume contact center, assisting clients with insurance policies, claims, benefits, and tax-related inquiries.
- Researched account information, resolved routine inquiries, and routed complex issues to appropriate departments for efficient handling.
- Managed multiple customer interactions, ensuring accuracy and professionalism to uphold service standards.
Office Administrator
GUARDIAN SYSTEMS N.W.
- Coordinated daily administrative operations, maintained customer records, and ensured accuracy in data entry and account maintenance to support efficient workflow.
- Supported accounts payable and accounts receivable processes while managing incoming calls, emails, and general inquiries to enhance customer service experience.
- Maintained professional relationships with clients, vendors, and business contacts to foster collaboration and facilitate effective communication.
Education
General Education Diploma (GED) -
Portland Community College (PCC)
Criminal Justice
Mt. Hood Community College
Grantham University
Skills
- Concurrent Review & Medical Management Support
- Inpatient Admission & SNF Authorization Coordination
- Medical Records Management
- Claims Processing Support
- Healthcare Operations & Case Processing
- Provider, Facility & Clinical Team Communication
- Medicare & Medicaid Member Services
- Appeals & Grievances
- Patient Advocacy & Account Resolution
- Data Entry, Reporting & Excel Tracking
- Epic Facets Microsoft Excel Microsoft Office MyChart EHR management Health information systems Secure Provider and Facility Portals
- Confidential Information Handling & HIPAA Awareness
- Workflow optimization
- Spanish-English Communication
Personal Information
Title: HEALTHCARE OPERATIONS | MEDICAL MANAGEMENT | ADMINISTRATIVE SUPPORT
Timeline
Medical Management Technician Concurrent Review Department
PROVIDENCE HEALTH PLAN
12.2019 - Current
Office Administrator
GUARDIAN SYSTEMS N.W.
Contact Center Representative I
THE STANDARD / VOLT WORKFORCE SOLUTIONS
Office Administrator
PRIDE STAFF
Public Programs Specialist
PROVIDENCE HEALTH PLAN
Legal Account Specialist
PROVIDENCE HEALTH & SERVICES
Office Assistant II Legal Team
PROVIDENCE HEALTH & SERVICES
General Education Diploma (GED) -
Portland Community College (PCC)
Criminal Justice
Mt. Hood Community College
Grantham University