Mary Pendleton
Olympia,WA
Summary
I am a devoted PSW employee with over 13 years of experience in the claims team, including more than 2 years as supervisor and over 4 years as claims team lead. My knowledge of the company and our culture is vast and valuable. I bring an understanding of the company's mission and vision as they've progressed and the company has grown and diversified. My leadership of the claims team facilitated our ability to grow and take on new challenges. I appreciate the opportunity to expand my skill set as manager of the claims team.
Overview
13
13
years of professional experience
Work History
Claims Team Supervisor
PSW
Olympia, WA
12.2010 - Current
- Supervised 8-10 claims team members and customer service representatives.
- Ensured compliance with applicable laws, regulations, policies, and procedures related to claims processing.
- Conducted regular meetings with team to discuss any issues or problems related to claims processing.
- Provided technical guidance and assistance in resolving complex or difficult claims-related issues.
- Monitored team performance and provided feedback to individual members on their progress.
- Identified areas of improvement within the department and recommended solutions as needed.
- Assisted in developing training programs for new employees on claim processes and procedures.
- Managed day-to-day operations of the Claims Team including scheduling, assigning tasks, monitoring progress.
- Adhered strictly to company policies pertaining to privacy and confidentiality requirements when dealing with sensitive information.
- Adhered strictly to HIPAA and ensured understanding by all team members of HIPAA regulations.
- Evaluated current processes used by the team and made recommendations for improvements when necessary.
- Supervised claim team members by providing guidance, support, mentoring, coaching.
- Identified areas where processes could be improved or streamlined.
- Conducted regular meetings with the team to review workloads and ensure any potential risks were identified and addressed.
- Reviewed existing policies and procedures for claims handling, making recommendations for changes as necessary.
- Recruited new staff members when required, assisted with conducting interviews.
- Scheduled training sessions for new staff members on company policies, systems and procedures related to claims processing.
- Provided guidance, support and mentoring to claims team members.
- Planned and led team meetings to ensure communication of priorities and company activities.
- Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.
- Mentored team members in professional development and growth.
- Recruited and trained new employees to meet job requirements.
- Maintained up-to-date knowledge of industry trends and best practices.
- Delegated work to staff, setting priorities and goals.
- Assisted in the development of training materials and methodologies related to claims processing.
- Assisted in the development of departmental policies and procedure related to claims processing.
- Interpreted health plan benefits in conjuction with hospital and professional contract specifications
- Developed and maintained knowledge of Medicare guidelines, ASA, RVS, CPT, DRG, HCPCS, RBRVS, ICD-10, UB-04 coding.
- Maintained CPC certification since 2017.
- Conducted weekly check runs, ensured proper auditing, sequestering, moving of claims and accurate payment to providers.
Education
Medical Insurance Coding
CPC Certification
Seattle, WA09-2017
Some College (No Degree) -
The Evergreen State College
Olympia, WASkills
- Staff Development
- Claims Investigation
- Training and mentoring
- Claims Management
- Policy Interpretation
- Task Delegation
- Process Improvement
- Problem-Solving
- Employee Coaching and Mentoring
- Adaptability and Flexibility
- Positive Attitude
- Relationship Building
- Team Leadership
- Problem Resolution
- Excellent Communication
- Reliability
Timeline
Claims Team Supervisor
PSW
12.2010 - Current
Medical Insurance Coding
CPC Certification
Some College (No Degree) -
The Evergreen State College