Rabeka Thompson
Odessa,United States
Summary
Versatile Management Analyst with advanced knowledge of financial, business development and operational areas. Steps into new areas with adaptable approach. Practiced project manager and problem-solver with 8 years of experience in aviation and over 10 years experience in healthcare configuration.
Overview
21
21
years of professional experience
Work History
Claims Dispute and Strategy Analyst Non-Covered
Natera
04.2023 - Current
- Establishes the patient authorized appeal process for medical necessity and experimental denials
- Project manages patient authorized appeals to see cases are sent to external review
- Expand and exhaust provider level appeals (including but not limited to underpaid, out of network, Prior auth, bundling, coding appeals)
- Monitors claims, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for assigned product
- Conducts monthly audits on third-party vendor to ensure process and workflows are being adhered and payment accuracy against contracted reimbursement rate
- Establishes an ongoing working relationship with other departments impacting appeal resolution
- Works closely with the vendor operations teams to oversee operations activity that directly impact assigned product appeal process
- Tracks appeal outcomes for assigned product to ensure KPIs and goals are met
- Participates in weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities
- Continually reviews and monitors payor appeal changes to determine process update and actions
- Coordinates with Management to ensure thorough understanding of trends/issues affecting assigned appeal performance.
Clinical Analyst
Avalon Healthcare Solutions
06.2021 - 04.2023
- Works closely with Medical Policy and Configuration Management to ensure the proper translation of medical policies into business rules and correct implementation in the Avalon claims editor
- Assists in ICD and CPT/HCPCS codes within medical policies annually and quarterly
- Assists in developing business rules from medical and payment policies including rationale for interpretation, supporting evidence, and documentation
- Determine coverage overlaps with government programs
- Creates test cases to ensure the proper configuration and implementation of business rules into the Avalon Claims Editor.
Contract Development Specialist
Kaiser Permanente
01.2019 - 06.2021
- Large group, small group and Federal membership contracts
- Helps to solve member benefit questions and compliance questions regarding health plan policies as well as Washington state health care and Medicare billing and coverage policies and guidelines.
Assistant Cheer Coach
Kent School District
07.2018 - 05.2019
Special Education Paraeducator
Kent School District
10.2018 - 01.2019
Senior Configuration Analyst
Molina Healthcare
11.2016 - 03.2018
- Supervising the transition of Optum's CES roles and responsibilities to Molina Healthcare Inc
- Testing rules and building rules and rule-sets within the system to maintain various state level Medicaid and Medicare billing requirements.
Configuration Analyst II
Molina Healthcare
03.2016 - 11.2016
- Contract and Benefit Configuration for Florida, New Mexico and Utah health plans under Molina Healthcare Inc.
Business Analyst
Molina Healthcare
12.2014 - 03.2016
- Responsible for submitting Contract Configuration Request Forms (CCRFs), researches claims issues regarding contracts built into TriZetto QNXT database
- Runs operational reports from QNXT via Microsoft SQL Server 2008
- Checks contract configuration within TriZetto QNXT for errors and assists with data clean-up
- Leading and participating in JAD sessions, preparing and reviewing Project Documents and Deliverables
- Implement and use software and systems to support the department's goals.
Provider Contract Coordinator
Molina Healthcare
05.2013 - 12.2014
- Maintains contracts for current and prospective providers interested in joining Molina's provider network
- Experience working in Microsoft Office
- Submits Contract Configuration Request Forms (CCRF) as well as configures new contracts and providers in the QNXT Testing Environment database
- Researches codes, reimbursement rates and claims in the QNXT Production database for Medicaid and Medicare
- Helps run reports using Microsoft SQL Server Management Studio
- Administrator for Provider Update Form (PUF) database that is configured using Microsoft Access
- Compiles and submits Provider Interest Committee spreadsheet weekly as well as sending off provider files to be credentialed
- Works in communicating with providers their status of their contracts as well as any other issues that arise
- Assists with the Legacy project in contracting database, Emptoris.
Aviation Maintenance Administration
US Navy
11.2003 - 03.2012
- Aviation Maintenance Administrationman Second Class, Nov 2003 - Mar 2012 (8 years 5 months), -Scheduling aircraft inspections and issuing work orders -Inspecting and performing detailed maintenance on all internal and external aircraft systems -Operating and maintaining aircraft launch and landing gear systems -Maintaining engine logbooks and associated aircraft records -Compiling data on aircraft system reliability trends -Managing libraries of technical publications and reports -Support of 17 MH-60S helicopters at Helicopter Sea Combat Squadron 21 in San Diego, CA
- -Attended the Aeronautical Technical Publications Library School (ATPL) -Maintained the ATPL of over 450 publications at Helicopter Sea Combat Squadron 41 in San Diego, CA
- -Trained to be a Data Analyst and System Administrator for the Naval Logistics Command Management Information System (NALCOMIS)
Education
Bachelor of Science - BS - Business Administration and Management, General
Capella University
01.2023
Skills
- Analytical mindset
- Trend forecasting
- Scenario Planning
- Business Intelligence
- Problem-solving abilities
- Reliability
- Attention to Detail
- Adaptability and Flexibility
- Data Collection
- Teamwork and Collaboration
- Written Communication
- Analytical Skills
Currentjob
Claims Dispute Analyst, Natera, Odessa, Florida, 04/2023, Present, 1 year 5 months, At Natera, my focus lies in refining the patient authorized appeal process for medical necessity and experimental denials. Through diligent project management, we've ensured that appeals are comprehensively addressed, significantly enhancing the provider level appeal process. My skill set includes robust problemsolving and analytical prowess, pivotal in identifying trends and spearheading initiatives that drive performance enhancements within our claims management system. Collaborating with cross-functional teams, we've instituted monthly audits to validate third-party vendor compliance, ensuring adherence to workflows and payment accuracy. This interaction has cultivated ongoing relationships with departments impacting claims resolution. My commitment is anchored in optimizing health care services, leveraging meticulous analytical skills to elevate patient and provider experiences in the landscape of genetic testing and health care solutions.
Timeline
Claims Dispute and Strategy Analyst Non-Covered
Natera
04.2023 - Current
Clinical Analyst
Avalon Healthcare Solutions
06.2021 - 04.2023
Contract Development Specialist
Kaiser Permanente
01.2019 - 06.2021
Special Education Paraeducator
Kent School District
10.2018 - 01.2019
Assistant Cheer Coach
Kent School District
07.2018 - 05.2019
Senior Configuration Analyst
Molina Healthcare
11.2016 - 03.2018
Configuration Analyst II
Molina Healthcare
03.2016 - 11.2016
Business Analyst
Molina Healthcare
12.2014 - 03.2016
Provider Contract Coordinator
Molina Healthcare
05.2013 - 12.2014
Aviation Maintenance Administration
US Navy
11.2003 - 03.2012
Bachelor of Science - BS - Business Administration and Management, General
Capella University
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