Tamera Phelps
Granite City,IL
Summary
Organized and motivated leader eager to apply 25 years of revenue cycle management skills in various environments. Seeking a position where I can utilize my knowledge of Medicare & Medicaid payors and processes to enhance the performance of the company while maximizing opportunities to expand skills while facilitating company growth.
Overview
24
24
years of professional experience
Work History
Claims Supervisor
Lumeris
St. Louis, MO
07.2022 - Current
- Managed a team of 10 Claims Representatives to ensure accuracy and timely completion of all claims processing activities.
- Responsible for monitoring incoming workload on a daily basis through SSRS reporting system for claims, calls, adjustments, etc.. to ensure all claims department work was completed with accuracy and in a timely manner to meet all CMS requirements.
- Assigned daily work assignments to the claims department through Facets, Trello and spreadsheets when necessary.
- Performed quality assurance reviews on claims submitted by staff to ensure compliance with company standards.
- Researched complex claim issues in order to resolve disputes between parties involved in a claim.
- Monitored and tracked performance metrics such as turnaround times, resolution rates, denial rates. for the Claims Department.
- Created reports on overall department performance and communicated findings at monthly meetings with management team.
- Collaborated with other departments such as Underwriting, Customer Service, Risk Management. to identify areas of improvement in the claims process.
- Ensured that all regulatory requirements were met when processing claims including HIPAA privacy rules and state-specific laws related to insurance coverage.
- Evaluated and motivated employees to continuously develop and grow in both performance and knowledge.
- Developed and implemented operational plans and procedures to enable successful team operations.
- Managed team members effectively to meet high production standards with accurate results.
Reimbursement Manager
Numotion
St. Charles, MO
03.2013 - 04.2022
- Provided personnel development by mentoring employees through one on one meetings, holding weekly staff meetings and team building activities.
- Adhered to corporate confidentiality guidelines and federal regulations in protecting patient data and ensuring all staff maintained compliance training requirements.
- Streamlined department's workflows by assessing billing and collections processes and making appropriate changes.
- Monitored accounts receivables and assessed payor account listings, checking for appropriate information processing.
- Ensured reimbursement was paid correctly based on fee schedules and contracts in place with payers. Also ensured our system was loaded correctly to prevent revenue adjustments and overbooking of account receivables to book accurate revenue.
- Selected by Senior Leadership team as part of the Change Management team for COVID19 and the Diversity and Inclusion team.
- Developed recommendations for improvement of organization's personnel policies and practices.
- Administered bi-weekly payroll for 25+ employees using ADP payroll systems.
- Conducted randomized feedback surveys.
- Worked closely with auditors on compliance testing of Medicare, Medicaid and Commercial plans.
- Managed MCO payer team and BCBS team. Responsible for all billing and collections processes for over 70 payers.
- Constructed detailed job descriptions and classification systems to define job levels and families.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
- Juggled multiple projects and tasks to ensure high quality and timely delivery.
- Prioritized and organized tasks to efficiently accomplish service goals.
Government Reimbursement Manager
Apria Healthcare
St. Louis, MO
08.2000 - 03.2013
- Revenue Cycle Management for Medicare and Medicaid payers
- Denial analysis for trending issues to adjust the day to day work flow of processes to improve denial rates.
- Quality review of team performance to improve denial rates, cash collections, aged account collections and appeal success rates.
- Communicated with all areas of the company (branches, compliance, contracting, SLT) to improve processes necessary to meet all company accounts receivable goals.
- Utilized Change Management to work through the difficult process of moving collections positions offshore while ensuring day to day operations were continued with quality during the transition which ultimately ended with jobs lost.
- Responsible for the training of the offshore management team (train the trainer) onshore before moving the processes offshore.
- Assisted with the training of offshore employees once the management team had been trained. This was achieved by traveling to India in 30 day stays to train the teams and ensure the processes were running smoothly.
- Maintained the offshore processes by working to improve original layouts, performing quality checks of all work completed offshore and providing feedback to make necessary improvements.
Education
High School Diploma -
GCHS
Granite City, Il05.1988
Bachelor of Science - Nursing
Southeast Missouri State University
Cape Girardeau, MOSkills
- Revenue cycle management
- Mentoring
- Contract negotiation
- Analytics skills
- Issue resolution
- Billing and collections procedures
- Program design
- Relationship building
- Communication
- Problem resolution
- Data Management
- Troubleshooting
- Computer skills
Timeline
Claims Supervisor
Lumeris
07.2022 - Current
Reimbursement Manager
Numotion
03.2013 - 04.2022
Government Reimbursement Manager
Apria Healthcare
08.2000 - 03.2013
High School Diploma -
GCHS
Bachelor of Science - Nursing
Southeast Missouri State University
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