Summary
Overview
Work History
Education
Skills
Timeline
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Casandra Wafford

Waxahachie,TX

Summary

Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.

Overview

17
17
years of professional experience

Work History

REIMBURSEMENT SUPERVISOR

UTSW Medical Center
01.2023 - Current
  • Improved reimbursement processes by analyzing and streamlining workflow procedures.
  • Supervised 5 employees of reimbursement specialists, ensuring timely and accurate processing of claims.
  • Provided ongoing support to team members with challenging case scenarios, fostering professional growth and development within department.
  • Streamlined appeals process for denied claims, resulting in higher success rate for overturning decisions and capturing lost revenue.
  • Established strong relationships with insurance providers through open communication channels, improving negotiation outcomes for payment disputes.
  • Cultivated positive work environment by recognizing team achievements and promoting collaboration among colleagues.
  • Followed up on denied and unpaid claims to resolve problems and obtain payments.
  • Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
  • Delivered timely information to insurance representatives to resolve common and complex issues.
  • Interceded between employees during arguments and diffused tense situations.
  • Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
  • Reduced processing times by effectively managing high volume of authorizations, referrals, and appeals.
  • Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
  • Developed strong relationships with insurance representatives to expedite approvals and resolve issues promptly.
  • Contributed to revenue growth by identifying opportunities for additional services requiring authorization within organization.

Revenue Cycle Manager

United Surgical Partners
01.2020 - 01.2023
  • Managed cross-functional teams to improve overall revenue cycle operations.
  • Improved revenue cycle efficiency by streamlining processes and implementing best practices.
  • Increased cash flow through timely resolution of payer denials and underpayments.
  • Established strong relationships with payers, improving communication and resolving disputes more effectively.
  • Provided staff training on revenue cycle management best practices, increasing productivity across department.
  • Streamlined workflows to minimize claim rejections and maximize reimbursement rates from insurance providers.
  • Coordinated with finance team to produce accurate monthly reports on collection metrics and trends.
  • Monitored industry trends to anticipate changes that may impact organization''s revenue cycle performance.

Manage Care Consultant

Advance Healthcare Solutions
09.2015 - 01.2020
  • Supervised 11 team members of reimbursement specialists, ensuring timely and accurate processing of claims.
  • Enhanced customer satisfaction with timely resolution of complex medical claims.
  • Verified patient insurance coverage and benefits for medical claims.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Followed up on denied claims to verify timely patient payment and resolution.
  • Responded to correspondence from insurance companies.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.

Medical Claims Analyst

UTSW Medical Center
11.2007 - 09.2015
  • Improved customer satisfaction by resolving complex medical claims in timely and professional manner.
  • Ensured accurate payments by meticulously reviewing medical records, invoices, and supporting documentation.
  • Provided exceptional customer service, addressing inquiries regarding coverage, benefits, and claim statuses promptly and professionally.
  • Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
  • Stayed current on industry trends and changes in insurance policies, enabling accurate interpretation of coverage details for various plans.
  • Stayed current on industry regulations and trends to ensure compliance and optimize insurance follow-up strategies.
  • Participated in regular staff meetings to discuss and strategize action plans for problematic accounts, resulting in improved collections performance.
  • Monitored aged account receivables closely to identify trends affecting payment cycles.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Followed up with customers about resolved issues to maintain high standards of customer service.

Education

Master of Science - Healthcare Administration

Strayer University
Dallas, TX
04.2021

Bachelor of Science - Healthcare Administration

Columbia Southern University
Orange Beach, AL
05.2015

Skills

  • Revenue Cycle Management
  • Excellent Communication
  • Coaching and Mentoring
  • HIPAA Compliance

Timeline

REIMBURSEMENT SUPERVISOR

UTSW Medical Center
01.2023 - Current

Revenue Cycle Manager

United Surgical Partners
01.2020 - 01.2023

Manage Care Consultant

Advance Healthcare Solutions
09.2015 - 01.2020

Medical Claims Analyst

UTSW Medical Center
11.2007 - 09.2015

Master of Science - Healthcare Administration

Strayer University

Bachelor of Science - Healthcare Administration

Columbia Southern University

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Casandra Wafford