Merideth Shideler
Sun City,AZ
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
25
25
years of professional experience
Work History
Encounter Data Supervisor
OptumCare
01.2023 - Current
- Supervise, train, and upskill employees and manage team’s productivity and goals
- Manage a team of 10 processors to research and resolve billing inconsistencies, ensure CMS adherence, and report results to operational areas and health plans
- Successfully trained and upskilled 20+ employees, resulting in several promotions
- Collaborate with engineering to create consistent reporting of inventory and metrics
- Document findings for processing updates
- Responsible for testing and reporting of former company platform and run-out for dissolution of business.
- Coordinated with other supervisors, combining group efforts to achieve goals.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Delegated work to staff, setting priorities and goals.
- Guided employees in handling difficult or complex problems.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
- Discussed job performance problems with employees, identifying causes and issues to find solutions.
- Reviewed employees' work to check adherence to quality standards and proper procedures.
- Reviewed reports on employee attendance, productivity and effectiveness to evaluate performance.
- Recruited, interviewed and selected employees to fill vacant roles.
- Implemented departmental policies and standards in conjunction with management to streamline internal processes.
- Recommended solutions related to staffing issues and proposed procedural changes to managers.
- Researched and prepared reports required by management or governmental agencies.
Claims Rework and Revenue Supervisor
OptumCare
06.2020 - 12.2022
- Supervise, train, and upskill employees and manage team’s productivity and goals
- Responsible for assisting with implementation of new company, identifying inconsistencies, and making recommendations to drive quality
- Identified 1.4 million dollars in unrecoverable revenue and submitted changes in reporting to drive long-term solution and recovery
- Reporting changes resulted in identification of 200k in invalid overpayments and additionally resulted in more than 100k in write-offs for uncashed checks.
- Evaluated and motivated employees to continuously develop and grow in both performance and knowledge.
- Managed team members effectively to meet high production standards with accurate results.
- Trained new team members on policies and procedures for claims handling.
- Motivated team members to maintain targeted turnaround time to obtain processing goals.
- Oversaw onboarding processes for new team members, delivering training on claims handling.
- Collaborated with quality team regarding quality assurance reviews.
- Conducted meetings to discuss issues and find pertinent solutions to claim and revenue problems.
- Created and updated financial reports on frequent basis to present information to leadership teams.
- Coordinated preparation of external audit materials and external financial reporting.
Claims Specialist
Northwest Physicians Network
Tacoma, WA
01.2017 - 06.2020
- Responsible for resolving complex claims, identifying inconsistencies, and assisting claim processors with questions and claim reviews
- Communicated with other departments to establish action plans and manage open claims to closure.
- Planned and conducted investigations of claims to confirm coverage and compensability.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Investigated and analyzed requirements to improve timeliness of reports to customers.
- Assessed and conducted negotiations within authority limits to settle claims.
- Documented specific claims by completing and recording forms, reports and logs.
- Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
- Determined covered insurance losses by studying provisions of policies or certificates.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Collaborated with fellow team members to manage large volume of claims.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Organized information by using spreadsheets, databases or word processing applications.
Healthcare Insurance Contractor
Healthcare Resource Group
Spokane, WA
12.2011 - 05.2013
- Traveled throughout country as claims specialist and auditor for multiple entities
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Negotiated and settled claims according to information presented through reports, research and data verification.
- Completed required investigations on referred files within established timeframes.
- Gathered information from various third parties to determine claim acceptability.
- Analyzed and audited open claims to calculate additional payments owed.
- Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.
- Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.
- Discovered occurrences of insurance fraud or criminal neglect to avoid workplace liability.
Claims Adjustment Analyst Contractor
Perot Systems
Dallas, TX
01.2010 - 08.2010
- Reviewed coverage determinations, investigated and evaluated claims.
- Assessed processing reports each day to effectively submit claims.
- Investigated and analyzed requirements to improve timeliness of reports to customers.
- Input claim information and payments into company database.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.
Billing Audit Contractor
Misha Faustina, MD
Phoenix, AZ
12.2008 - 05.2009
- Prepared and conducted billing audit for Oculoplastic Surgeon Office.
- Developed and maintained agreements to standardize terms and conditions between company and subcontractors or consultants.
- Refined and improved company processes to increase productivity and efficiency.
- Delegated work to staff, setting priorities and goals.
- Monitored project progress to enforce adherence to deadlines and quality standards.
Insurance Contractor
Healthcare, Jacobson Solutions
Chicago, IL
02.2007 - 11.2008
- Completed required investigations on referred files within established timeframes.
- Investigated questionable claims to determine payment authorization.
- Analyzed and audited open claims to calculate additional payments owed.
- Gathered information from various third parties to determine claim acceptability.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Negotiated and settled claims according to information presented through reports, research and data verification.
- Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.
Claims and Benefits Representative II
Blue Cross Blue Shield of MI
Detroit, MI
05.1998 - 06.2006
- Evaluated, processed, and adjusted medical claims
- Strategize with partner areas to diagnose root issues and remediate pricing and configuration concerns
- Regularly communicate with health plans and attend collaboration meetings to identify and correct processes for high level matters
- Successfully trained and upskilled 20+ employees, resulting in several promotions
- Upskilled teammates in detailed research to ensure end to end correction of configuration, pricing, and provider data
- Conduct deep dive analysis of claims payment accuracy, identify inconsistencies, document and record results for configuration, training, and SOP updates.
- Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote service times.
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Examined claims, records and procedures to grant approval of coverage.
Education
GED -
Corvallis Adult Education
Some College (No Degree) -
Davenport University
Grand Rapids, MISkills
- 20 years Healthcare Insurance Industry Knowledge
- Strategic Planning
- Operations Management
- Customer Service
- Performance Management
- Database Maintenance
- Documentation and Recordkeeping
- Financial Reporting
- Workflow Planning
- Leadership and Change Management
- Microsoft Office
- Data Entry
- Accounts Payable and Receivable
- Payroll Administration
- Decision-Making
- Administration and Operations
- Program Development
- Relationship Building
- Employee Supervision
- Regulatory Compliance
- Phone and Email Etiquette
- Schedule Management
- Multitasking and Organization
- Motivational Leadership
- Cross-Functional Collaboration
- Handling Complaints
- Account Reconciliation
- Meeting Coordination and Support
- Root Cause Analysis
- Staff Development and Training
- Coaching and Mentoring
- Quality Assurance
- Team Leadership
- Report Preparation
References
References
Available Upon Request
Timeline
Encounter Data Supervisor
OptumCare
01.2023 - Current
Claims Rework and Revenue Supervisor
OptumCare
06.2020 - 12.2022
Claims Specialist
Northwest Physicians Network
01.2017 - 06.2020
Healthcare Insurance Contractor
Healthcare Resource Group
12.2011 - 05.2013
Claims Adjustment Analyst Contractor
Perot Systems
01.2010 - 08.2010
Billing Audit Contractor
Misha Faustina, MD
12.2008 - 05.2009
Insurance Contractor
Healthcare, Jacobson Solutions
02.2007 - 11.2008
Claims and Benefits Representative II
Blue Cross Blue Shield of MI
05.1998 - 06.2006
GED -
Corvallis Adult Education
Some College (No Degree) -
Davenport University