Maya Henderson
Summary
Results-oriented Arbitration Consultant with a Master's degree in Dispute Resolution and extensive experience in managing arbitration processes related to No Surprise Act. Proven track record of overseeing complex arbitration cases with a focus on delivering fair and efficient dispute resolution outcomes. Skilled in leading teams of Arbiters, fostering collaboration, and ensuring adherence to procedural standards and ethical guidelines. Adept at leveraging technology and innovative approaches to streamline arbitration procedures and enhance client satisfaction. Committed to upholding the highest standards of professionalism, integrity, and confidentiality in all arbitration activities. Seeking to leverage expertise and leadership capabilities to drive excellence in arbitration management within a dynamic organization.
Overview
13
13
years of professional experience
Work History
Federal Arbitration and Appeals Consultant
R1RCM Revenue Cycle Management
05.2022 - Current
- Managed global team responsible for coordinating activities relating to the No Surprises Act (NSA) Federal independent dispute resolution (IDR) process
- Proactively assessed and managed business processes to determine the most effective and efficient ways of processing the initiating party's IDR cases
- Oversee preparation of data, statistics, narratives, graphs, and reports for communicating and managing NSA volumes and outcomes
- Serves as the primary interface between R1 RCM, Government Contracts, Federal laws, and other related business counterparts to ensure standard processes are implemented and followed
- Developed and maintained a working process of the Open Negotiation guidelines, notices, and requests before formal arbitration
- Monitor cases submitted to the CMS portal to initiate a notice of the Federal IDR offer process, following the selection of the certified IDR entity
- Responsible for preparing, submitting, and following the IDR Notice of Offers for all arbitration dispute cases to CMS with the Certified IDR entity fees due within the timely filing deadlines.
Compliance Analyst, Appeals and Dispute Resolution Management
American Health Plans
01.2019 - 01.2022
- Lead team that captured, investigated, and responded to all complaints regarding provider appeals and underpayment disputes related to services, benefit coverage issues, timely filing, medical necessity, and authorization denials
- Monitored all incoming appeals, grievances, and payment disputes to ensure cases were completed within the required deadlines
- Escalated issues appropriately and worked with other departments to resolve issues promptly
- Identified trends on denial issues and root causes of appeals and disputes and investigated any underlying factors
- Conducted CMS Appeals audit to review complex claims using CMS Pricer, and FFS (Fee for Service)
- Monitored the overall effect our efforts had on our revenue cycle
- Encouraged an atmosphere of optimism, warmth, and interest in teamwork and collaboration with other departments in achieving operational excellence
- Developed Standard Operation Procedures and workflow processes to ensure efficiency in managing appeals and dispute resolution within the department
- Managed special projects and provided regulatory monitoring, reporting, developing, and implementation of compliance audit recommendations
- Screened, interviewed, hired, and trained new employees.
Claims Processor/Claims Dispute Resolution Lead
Wellcare Health Plans
11.2011 - 03.2019
- Adjudicated Medicare/Medicaid claims for Tennessee, Arkansas, Mississippi, South Carolina, Texas, Louisiana, and Florida
- Worked with providers and management executives to resolve reimbursement discrepancies on time
- Managed all provider and member disputes
- Improved claims dispute processing times by resolving adjustments and resolution quickly
- Collaborated with internal resources to address issues
- Performed root cause analysis to identify performance gaps and created detailed and summary reports
- Updated training curriculum and created a processing manual to address counterintuitive requirements in departmental guidelines resulting in increased operating efficiency
- Processed complex claims held back for various reasons.
Education
Masters of Arts - Dispute Resolution
Touro University Worldwide
01.2019
Certificate - Medical Coding, Billing, and Claims
Ashworth College
01.2013
Masters of Divinity - Pastoral Care & Counseling
Philippine Baptist Theological Seminary
01.1996
Bachelor of Arts - Psychology
Philippine Christian University
01.1994
Skills
- Problem-Solving
- Attention to Detail
- Team Leadership & Development
- Client Relationships
- Analytical Thinking
- Integrity and Honesty
- Dispute Resolution
- Staff Management
- Research and Development
Volunteer Experience Training
- Operation Mobilization, MV Doulos international crew, 2 years, Worked with 350 people from 60 nations, managed the world's largest floating bookstore with at least 5,000 titles, and managed crowd control with thousands of visitors daily.
- Provide administrative management, guidance, and leadership team training for field staff, 1 year, 50 full-time humanitarian workers in Kazakhstan and Central Asia
- Jefferson Regional Medical Center, Hospital Chaplain, 1.5 years, Full-time Hospital Chaplain at Jefferson Regional Medical Center in Arkansas
- Orphanage, Counselor, 1 year, Guiding and training young girls ages 2 – 16
Technical Experience
Microsoft Teams, Word, Excel, PowerPoint, ICD and CPT coding guidelines, contract reimbursement terminology, medical terminology, CMS Compliance Regulations, Medicare Advantage health plans, Claims processing and adjudication, Coordination of Benefits (COB), Correspondence, Provider and Member Dispute Resolution, Arbitration, Mediation, Team Facilitation, Exelys, Webstrat, UltiPro (UKG), HealthAxis
References
Available upon request.
Timeline
Federal Arbitration and Appeals Consultant
R1RCM Revenue Cycle Management
05.2022 - Current
Compliance Analyst, Appeals and Dispute Resolution Management
American Health Plans
01.2019 - 01.2022
Claims Processor/Claims Dispute Resolution Lead
Wellcare Health Plans
11.2011 - 03.2019
Masters of Arts - Dispute Resolution
Touro University Worldwide
Certificate - Medical Coding, Billing, and Claims
Ashworth College
Masters of Divinity - Pastoral Care & Counseling
Philippine Baptist Theological Seminary
Bachelor of Arts - Psychology
Philippine Christian University
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