Jessica Pearce
Fairhope,AL
Summary
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.
Overview
14
14
years of professional experience
Work History
Lead Qualifications Specialist
Synapse Health
11.2024 - Current
- Led the Elevation and Escalation Issue Resolution Team assisting patients with exceptional customer service to resolve problematic orders and de-escalate callers. The team works to coordinate effectively across various operations departments.
- Led the Resupply team by mentoring and coaching specialists within the qualifications department.
- Conducted audits of qualifications department orders to ensure that the needs of the patient, prescriber, and referral source are being met, and to verify adherence to compliance standards.
- Exceeded KPI goals by maintaining 100% QA and call evaluation scores throughout all quarters of 2024.
- Led cross-functional teams to enhance project outcomes by streamlining communication processes.
Senior Qualifications Specialist
Synapse Health
06.2023 - 11.2024
- Assisted with qualifications onboarding of a new capitation agreement with UHC plans, servicing over 250,000 patients.
- Answered inbound calls from patients, insurance companies, referral sources, and provider’s offices and maintained records of all communications.
- Maintained knowledge and stayed up to date on insurance guidelines for durable medical equipment.
- Created orders in multiple software systems for supplies and equipment using knowledge of HCPCS, allowable, quantities, and manufacturers of products.
- Prepared insurance cost estimates, collected patient coinsurance payments if applicable, explained rental and purchase options to patients, and handled pre-certifications and re-certifications.
- Assisted with the training department by mentoring new specialists within the qualifications department.
- Exceeded KPI and WFM goals consistently.
- Created training materials and facilitated training classes for new specialists in my department.
Qualifications Specialist
Synapse Health
04.2023 - 06.2023
- Answered inbound calls from patients, insurance companies, and providers
- Utilized outbound faxing system to request medical records, while maintaining HIPAA compliance
- Conducted outbound calls to patients and providers to stay up to date on follow-ups of record requests to ensure maximum customer satisfaction and experience
- Processed incoming communications from faxes, emails, and calls and resolved them accordingly
- Assisted launch of theOptum Breast Pump program
- Reviewing documentation for qualifications of medical equipment to ensure insurance coverage criteria are met
- Met and exceeded KPI and WFM goals consistently
Quality Documentation Specialist
Nuance Communications
06.2021 - 03.2023
- Created medical documentation utilizing DAX artificial intelligence for clinicians all over the United States to enable deeper patient clinician relationships, decrease clinical burnout, and increase overall patient satisfaction
- Adhered to strict deadlines for document turnaround time while ensuring quality documentation and EHR compliance
- Onboarded new providers using the DAX system by educating and communicating processes and workflows directly with the provider and their staff members
- Trained new team members in utilizing DAX and multiple types of EHR systems
- Audited work of less tenured team member’s work to ensure quality documentation standards were being upheld
Customer Service Representative
MedSouth, Inc
12.2019 - 06.2021
- Answered inbound calls from patients, insurance companies, and providers
- Assisted customers with technical and clinical knowledge of continuous airway pressure devices, nebulizers, oxygen therapy, and trilogy ventilators
- Assisted customers with billing inquiries
- Worked with healthcare providers and case managers to obtain documentation for insurance compliance
- Assisted with inventory management
Assistant Office Manager
Pulmonary & Critical Care, PC
05.2011 - 12.2019
- Started my career at this company as a medical receptionist, I gained knowledge of the healthcare industry - learning about insurance, customer service, time management, accounting, and clinical scheduling
- I was quickly promoted to Medical Assistant by the physician and trained directly by his Nurse Practitioner, whom I served as her assistant for nearly 4 years
- In that position, I gained clinical knowledge, such as triage, patient assessment, patient advocacy, and much more
- I was promoted again to Assistant Clinic Manager where I served until the practice closed for retirement
- During my time in that position, I was the primary clinical supervisor for the medical staff and directed the daily clinical operations
Education
Associate of Science - Health Sciences
James H Faulkner Community College
Bay Minette, AL05-2011
Skills
- Leadership
- Communication
- Problem Solving
- HIPAA Compliance
- Escalation Management
- ICD-10, CPT, & HCPCS coding
- Inventory & Payroll Management
Timeline
Lead Qualifications Specialist
Synapse Health
11.2024 - Current
Senior Qualifications Specialist
Synapse Health
06.2023 - 11.2024
Qualifications Specialist
Synapse Health
04.2023 - 06.2023
Quality Documentation Specialist
Nuance Communications
06.2021 - 03.2023
Customer Service Representative
MedSouth, Inc
12.2019 - 06.2021
Assistant Office Manager
Pulmonary & Critical Care, PC
05.2011 - 12.2019
Associate of Science - Health Sciences
James H Faulkner Community College
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