Summary
Overview
Work History
Education
Skills
Certification
Languages
Accomplishments
Work Availability
Quote
Software
Interests
Websites
Timeline
BusinessAnalyst
Jessica Raines

Jessica Raines

Petersburg,VA

Summary

Dedicated Reimbursement Specialist with 15+ years of experience in claims management, payer relations, and healthcare reimbursement. Proven expertise in resolving complex claims, ensuring compliance with Medicare/Medicaid regulations, and driving revenue optimization. Adept at working cross-functionally with healthcare providers, insurers, and stakeholders to streamline processes and improve reimbursement outcomes. Currently pursuing advanced training in Prior Authorization to enhance reimbursement efficiency. Excited to bring my skills to Cardinal Health, leveraging deep industry knowledge to support revenue cycle improvements and compliance.

Overview

19
19
years of professional experience
1
1
Certification

Work History

Reimbursement Specialist

VCU Health System
03.2019 - Current
  • Recovered 80%+ of unpaid claims, optimizing the appeals process and accelerating claim resolution.
  • Led revenue recovery efforts for high-cost medications, ensuring prior authorization compliance and accurate billing.
  • Collaborated with physicians, nurses, and insurers to streamline reimbursement workflows, reducing denials.
  • Maintained meticulous documentation using ICD-10, CPT, and HCPCS coding, improving claim accuracy and compliance.

Pharmacy Technician

VCU Health System
12.2005 - 03.2019
  • Managed inventory procurement and supplier coordination, reducing stockouts through proactive planning.
  • Achieved 99.9% prescription accuracy, implementing strict quality control measures.
  • Served as an AHEC Certified Spanish Interpreter, facilitating bilingual communication and patient privacy compliance.
  • Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.

Education

Associate's of Applied Science -

Bright Point Community College
Chester, VA
05.2022

High School Diploma -

Canyon High School
New Braunfels, TX
05.1999

Skills

  • Reimbursement & Claims Processing
  • Payer Relations & Insurance Negotiation
  • Appeals & Denials Management
  • Medicare/Medicaid Compliance
  • Revenue Cycle Optimization
  • Data Analysis & Billing Systems (Epic, Excel)
  • Stakeholder & Cross-Functional Collaboration
  • Spanish Bilingual Communication

Certification

  • Enrolled in Prior Authorization, PACS - ACMA
  • Certified Pharmacy Technician, PTCB & VA Board of Pharmacy
  • AHEC Certified Spanish Interpreter

Languages

English
Native or Bilingual
Spanish
Full Professional

Accomplishments

  • Collaborated with team of 3 in the development of PowerPoint presentation training.
  • Documented and resolved hospital account claims which led to patient credit back.

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote

Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful.
Albert Schweitzer

Software

Epic - For claims processing, patient records, and billing

Availity - For insurance verification & claims management

Microsoft Excel

Microsoft Word & Powerpoint

Google Sheets & Docs

Interests

Patient Advocacy - Dedicated to helping patients navigate financial barriers to care

Fitness & Wellness - Burn Boot Camp enthusiast; committed to staying active and healthy

Music & Dance - Passion for Latin music and salsa dancing

Timeline

Reimbursement Specialist

VCU Health System
03.2019 - Current

Pharmacy Technician

VCU Health System
12.2005 - 03.2019

Associate's of Applied Science -

Bright Point Community College

High School Diploma -

Canyon High School

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Jessica Raines