Jen Preas

In my current role at Rialtic I am responsible for overseeing the tactical execution of all of the Content team deliverables. I lead a team of eight analysts, ten offshore BPM analysts, and provide leadership support and guidance to three managers. My day to day execution activities include:

• Creating, assigning, and tracking tasks related to the creation and maintenance of Rialtic's claims edit policy library to align with planned roadmap items, as well as client needs.
• Hiring, onboarding, and training new employees, as well as mentoring the other content managers.
• Working cross-functionally with the client experience and engineering teams to deliver for our clients and program edits for our policy library.
• Reporting directly weekly to Rialtic's executive management team on the status of Content deliverables.
• Serving as a subject matter expert on the interpretation and design of Medicare, Medicaid, and general correct coding rules and edits.
• Meet with clients to present new policies and edits for review.

As an operations manager in Optum's external commercial Payment Integrity space I led a team of 17 senior recovery and resolution analysts who provided prepayment claims reviews and made payment recommendations based on medical record evaluations. I was also responsible for the assignment inventory management of the larger group of approximately 45 analysts. I was nominated as an Optum Superhero by my team in 2022. Additional duties and responsibilities included:

• Direct client support for provider queries related to claim denials.
• Attended and provided support in client governance meetings related to the creation and acceptance of additional rules and claim challenges.
• Provided support to the internal special investigations unit program piloted with our client.
• Provided administrative management for my team including tracking of quality, production, and attendance.
• Monthly one on ones with each member of my team to review quality, production, attendance, provide mentoring, and assist with career advancement as appropriate.
• Served as a subject matter expert on Optum's review guidelines, correct coding guidelines, and interpretation of medical records.

As Senior Recovery/Resolution Analyst at Optum I was responsible for reviewing medical records and providing pre-payment recommendations for claims within Optum's internal Medicare and Retirement line of business. I was recognized for my extremely low error rate and high level of production. I was eventually moved to Optum's Elite claims resolution team to identify and close claims at risk of exceeding SLAs.