Deborah Keene
Vinton,VA
Summary
Accomplished Operations Expert at Elevance Health with over 21 years experience in claims processing and problem-solving, achieving high levels of staff performance through effective training and process improvement strategies. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
21
21
years of professional experience
Work History
Operations Expert
Elevance Health
05.2022 - Current
- Streamlined claims processing by implementing efficient workflow procedures and leveraging technology to reduce turnaround time.
- Participated in ongoing professional development opportunities, staying current on industry trends and advancements relevant to role as Lead Claims Processor.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Applied excellent problem-solving, process development, and strategic implementation skills to lead and support all areas of operations.
- Created and managed knowledge base to address frequently asked questions and offer how-to guides and troubleshooting instruction.
- Set clear goals to monitor targets and offered real-time input on performance and motivation.
- Conducted regular reviews of operations and identified areas for improvement.
- Evaluated staff performance and provided coaching to address inefficiencies.
- Educated staff on organizational mission and goals to help employees achieve success.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
- Collaborated on operational support tasks to achieve common goal.
Lead Claims Processor
Elevance Health
04.2012 - 05.2022
- Streamlined claims processing by implementing efficient workflow procedures and leveraging technology to reduce turnaround time.
- Elevated team morale by fostering an inclusive work environment that promoted collaboration and open dialogue among colleagues.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Monitored and updated claims status in claims processing system.
- Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
- Served as a subject matter expert within the department, providing guidance and support to colleagues on complex or challenging claims scenarios.
- Consistently met or exceeded performance targets by effectively managing time and prioritizing tasks in a high-pressure work environment.
- Managed workload and priorities to meet claims processing meet deadlines.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
Claims Processor
Elevance Health
11.2003 - 04.2012
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
Education
Cave Spring High School
Roanoke, VASkills
- Strong Communication Skills
- Process improvement strategies
- Claims Processing Expertise
- Training and education
- Problem-Solving
- Time Management
- Decision-Making
- Staff Supervision
- Teamwork and Collaboration
- Multitasking Abilities
- Work Planning and Prioritization
- Process Improvement
Accomplishments
- Exceeded expectations on all of my Core Values for the past 5 years.
- Served as an Interim manager.
- Collaborated as a Subject Matter Expert with the development of Fusion.
- Created and implemented my own training plans.
- Assisted with Interviews.
- Supervised team of 30 plus claims processors..
- Successfully trained 2 new Claims Operations Experts and 5 new Claims Rep III's.
- Completed Customer Service Upskill training
Timeline
Operations Expert
Elevance Health
05.2022 - Current
Lead Claims Processor
Elevance Health
04.2012 - 05.2022
Claims Processor
Elevance Health
11.2003 - 04.2012
Cave Spring High School
Similar Profiles
Brittany OwensBrittany Owens
Customer Service Representative at Elevance HealthCustomer Service Representative at Elevance Health
Arthur LeeArthur Lee
Data Entry Specialist at Elevance HealthData Entry Specialist at Elevance Health
Rikki RamirezRikki Ramirez
Prior Authorization Specialist at Elevance HealthPrior Authorization Specialist at Elevance Health
Ibukun AkinadeIbukun Akinade
NA at Elevance HealthNA at Elevance Health
Angela EnglandAngela England
Hhr Attendant at Rosie's Gaming EmporiumHhr Attendant at Rosie's Gaming Emporium