Kimberly Tracy

• Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
• Educated employees on specific QA standards and confirmed maintenance of standards.
• Inspected items and compared against standards to meet regulatory requirements.
• Reported problems and concerns to management.
• Reviewed production processes and identified potential quality issues.
• Audit Claims,Adjustments Cash and Regular, VIP claims, Other insurance Verification routes and Case Management routes and claims
• Coached and Mentored QAA I and II's
• Trained QAA's on how to audit OPL specialists, OPL clerical, Regular and Cash Adjustments, Medicare Secondary Payor, Other Insurance Verification routes and claims and Case Management routes and claims
• Trained Claims Associates on regular Adjustments and Cash Adjustments
• Worked with Leadership to provide timely feedback while managing the work expectations appropriately
• Met with other QAA III's to discuss errors and questions recieved
• Create reports every four months for error trends for claims area
• Created monthly rotation for the QAA I's and II's
• Was lead QAA for Medicare Secondary Payor cases on OPL side and claims

Carefirst BCBS- Quality Assurance Speciaist III

• Audit claims,adjustments and Other Party Liability cases for Quality Assurance Specialists I and II
• Coached and Mentored QAA I and II’s
• Lead QAA for Medicare Secondary Payor
• Worked with QAA’s to help create standard operating procedures for the Other Party Liability and MSP specialists
• Met with other QAA III’s to discuss regular errors or questions recieved
• Created reports every four months for error trends for claims area
• Created monthly rotation for the QAA I and II’s
• Trained QAA’s on how to audit Other Party Liability

Worked with leadership to provide timely feedback while managing the work expectations appropriately

• Audit claims for Claims Processors
• Audit adjustments for Claims Adjusters
• Audit cash adjustments for Cash Adjusters
• Audit cases for Other Party Liability Analysts including Subrogation, Workers Compensation and No Fault
• Audit cases and claims for Medicare Secondary Payer processors and Medicare Secondary Payer Analysts
• Answer questions and provide coaching and technical expertise for Claims Processors, Claims Adjusters, Cash Adjusters, Other Party Liability Analysts and Medicare Secondary Analysts and Adjusters
• Provide weekly and monthly status reports for all Claims Processors, Claims Adjusters, Cash Adjusters, Other Party Liability Analysts MSP Analysts and MSP claims processors
• Lead QAA for Medicare Secondary Payor cases
• Lead Trainer for Other Party Liability Subrogation
• Assisted in Coaching and Questions for Claims Training classes
• Facilitated Other Party Liability Error trend meetings
• Lead in training of Quality Production Database
• Supported company in maintaining work environment focused on quality, communication, collaboration, integration and teamwork.

• Audited claims processors for accuracy
• Provided coaching for Claims processors and new Quality Assurance Analysts
• Piloted first Work at home Quality Assurance Analyst position
• Maintained weekly and monthly reports for supervisors
• Supported company in maintaining work environment focused on quality, communication, collaboration, integration and teamwork.