Open To Work
Jill Durham
Washington,DC
Overview
40
40
years of professional experience
Work History
Claims Resolution Analyst/Medical Reviewer
Carefirst BCBS/Protocol/BCBSNCA
Washington, District of Columbia
10.1992 - 01.2026
- Evaluated claims for compliance with policies and regulations.
- Determined if a claim is medically necessary for assistant surgeon or dry needling based on medical records sent from the provider
- Developed training materials for team members on updated claims procedures.
Graduate Nurse/Health Tech
DC General Hospital
Washington, D.C.
03.1989 - 09.1991
- Direct patient care.
- Clerical phone and taking off doctor's orders.
- Caring patients to various procedures.
- Monitoring Intravens Infusions.
- Health plans to the lab.
- Computer Input.
- Washington, ..
Accounting Clerk
Kaiser Permanente
Washington, D.C.
06.1986 - 03.1989
- Maintain the books for all the Pharmacies in the region.
- Maintain the books of all the centers.
- Process Center bags for the bank.
- Created spreadsheets for the PC.
- Clerical duties as needed such as answering the phone, distributing the pay, and typing.
- Persente, Washington, B.C.
Education
Master of Science -
Southeastern University
Washington, DC06.2005
Bachelor of Science - Computer Science
Southeastern University
Washington, DC06.2003
Certificate - Medical Assistant
National Education Center
Washington, DC07.1993
Associate of Science - Nursing
University of The District of Columbia
Washington, District of Columbia, DC12.1988
Skills
- Claims evaluation
- Medical necessity assessment
- Compliance auditing
- Claims processing
- Training development
- Regulatory knowledge
Work Preference
Job Search Status
Open to workWork Type
Full TimePart TimeLocation Preference
RemoteSalary Range
$45000/yr - $200000/yrTimeline
Claims Resolution Analyst/Medical Reviewer
Carefirst BCBS/Protocol/BCBSNCA
10.1992 - 01.2026
Graduate Nurse/Health Tech
DC General Hospital
03.1989 - 09.1991
Accounting Clerk
Kaiser Permanente
06.1986 - 03.1989
Master of Science -
Southeastern University
Bachelor of Science - Computer Science
Southeastern University
Certificate - Medical Assistant
National Education Center
Associate of Science - Nursing
University of The District of Columbia