JSJessica Stiles
@jessicastiles
Detail-oriented claims and appeals specialist skilled in Medicare and ACA compliance.
United StatesWhat I'm looking for
I am a detail-oriented Claims & Appeals Specialist with a strong foundation in Medicare and ACA compliance and a consistent record of producing audit-ready documentation.
In my current role I independently manage and process large caseloads—100+ monthly Medicare appeal cases—while ensuring 100% HIPAA and CMS compliance and meeting strict regulatory deadlines.
Previously I supported ACA eligibility and enrollment workflows, maintained high-accuracy member records across multiple systems, and handled back-office case processing with minimal member-facing contact.
I bring technical proficiency with CSA, eBoard, Vistio, Zendesk, and MS Office, plus experience in records management, quality assurance auditing, and written correspondence—skills I aim to apply in roles focused on independent case analysis and behind-the-scenes processing.
Experience
Work history, roles, and key accomplishments
Appeals Customer Service Rep
Acentra Health
Jan 2025 - Present (9 months)
Independently managed and processed 100+ monthly Medicare appeal cases, ensuring 100% HIPAA and CMS compliance and producing audit-ready documentation under strict regulatory deadlines.
Customer Support Representative
Washington Health Benefit Exchange
Jan 2024 - Jan 2025 (1 year)
Verified ACA eligibility and enrollment, updated member records across multiple systems with high accuracy, and supported back-office processing with audit-ready case notes exceeding quality benchmarks.
Managed customer order, account, and refund cases using Zendesk, focusing on accurate, compliance-ready case documentation and timely resolution.
Licensed Massage Therapist
Healthcare Clinics
Jan 2022 - Jan 2023 (1 year)
Maintained confidential HIPAA-compliant patient files while coordinating scheduling, insurance verification, and medical records processing to support clinical operations.
Cashier / Customer Service
Safeway
Jan 2014 - Jan 2022 (8 years)
Prepared daily financial reports and balanced tills in a high-volume retail setting, developing strong attention to detail and customer service skills.
Education
Degrees, certifications, and relevant coursework
YCYakima Valley College
Associate of Arts, Administrative Assistance
Completed an Associate of Arts in Administrative Assistance with coursework focused on office administration and records management; graduated September 2016.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
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