KIMBERLY D. RUCKER
OAKLAND,CA
Summary
Senior Case Manager at Kaiser Permanente specializing in grievance and appeals complex problem solving. Demonstrated ability to enhance member experiences through effective communication and sound judgment. Proficient in project management and software applications, consistently achieving compliance standards while efficiently resolving sensitive issues.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Senior Case Manager/ Grievance Department
Kaiser Permanente
Dublin, CA
10.2021 - Current
- Answer questions and manage existing/ open cases; Participates in handling the appeals/denials process; Ensures appeals are processed in accordance with regulations, compliance standards and policies and procedures; Meets timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.
- Investigates all issues, including collection of appropriate data, preparation, and presentation of documents to decision makers; Collaborates with internal staff, other UM Departments, Team managers and physicians to seek resolution on issues and cases affecting member while ensuring compliance, documentation and enhancing members' experience; Ensures integrity of departmental database by thorough, timely and accurate entry.
Inpatient Authorization Coordinator
BROWN & TOLAND MEDICAL GROUP
Oakland, CA
01.2021 - 09.2021
- Review and process all assigned prior authorization orders to completion; review the SNF/HH authorization request for service, generate denial letters, and send over the 72-hour NOMNC for state reasons.
- Coordinated communication between departments regarding authorization procedures; researched information as necessary to resolve customer inquiries or issues with authorizations.
- Developed training materials for new Authorization Coordinators and staff members; maintained accurate records of all authorizations in the system; collaborated with other departments within the organization to ensure the timely completion of authorizations.
Medical Office Administrator/ Manager
DR. AGBOWO MD
Oakland, CA
08.2018 - 12.2020
- Generate inventory records; Supervision of patient scheduling; Employee Scheduling; Coordination of the day-to-day operations of the practice Promoting excellent customer service by all levels of the staff; Responsible for the operations and administration side of a medical office.
- Ensures office is running smoothly by supervising office staff, hires, terminates, and trains employees, and oversees the billing portion of the office.
- Process company's response to claims; Submit billing statements to patients; Delegate responsibilities Assess employee performance Perform data entry and processing; Develop and implement office policies and procedures. Formulate objectives and processes; Generate inventory records; Supervision of patient scheduling; Coordination of the day-to-day operations of the practice Promoting excellent customer service by all levels of the staff.
Education
Bachelor’s degree - Health and Administration
University of Phoenix
Phoenix, AZ07.2020
Master’s Degree - Sports Management
Southern New Hampshire University
06.2012
Bachelor’s of Science (BS) -
University of California, Los Angeles
Los Angeles, CA05.2004
Skills
- Interpersonal skills
- Verbal and written communication
- Issue assessment
- Information gathering
- Software proficiency
- Work prioritization
- Sound judgment
- Complex problem solving
- Multitasking and time management
- Project management
- Grievance & Appeals process
- Basketball fundamentals
- Athlete education and teamwork promotion
- Personal growth facilitation
Coaching Experience
- Training of all ages from 7 and up, Silk Training Facility, 01/01/16, Present, Bay Area Locations
- Head Coach/ Co Director Ages 14u & 17u, West Coast United/ Legacy Bay Area National Team, 01/01/12, Present
- Middle School Girls Head Basketball Coach, Montera Middle School, 01/01/12, 01/01/16, OAKLAND, CA, Won Championship Titles while I was coaching there
- Asst. Girls Varsity Basketball Coach, Presentation, 01/01/20, 01/01/23, San Jose, CA
- Head Middle and High School Girls Varsity Basketball Coach, Valley Christian, 01/01/23, 01/01/25, Dublin, CA
Certification
- Nutritionist
- Strength and Conditioning
- Personal Training
- CPR
Timeline
Senior Case Manager/ Grievance Department
Kaiser Permanente
10.2021 - Current
Inpatient Authorization Coordinator
BROWN & TOLAND MEDICAL GROUP
01.2021 - 09.2021
Medical Office Administrator/ Manager
DR. AGBOWO MD
08.2018 - 12.2020
Bachelor’s degree - Health and Administration
University of Phoenix
Master’s Degree - Sports Management
Southern New Hampshire University
Bachelor’s of Science (BS) -
University of California, Los Angeles
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