Rebecca Ellender
Kingwood,TX
Summary
Multi-line Claims Supervisor dedicated to quality investigation, adjustment and supervision of diverse cases. Blends strategic planning and leadership strengths to establish top-performing claims departments. Trains and mentors staff, optimizing compliance with policies, procedures and applicable laws.
Overview
24
24
years of professional experience
Work History
Claims Supervisor
Productivity Network Innovations
Project Manager
Westerkamp Group, LLC
08.2021 - Current
- Streamlined project processes by implementing Agile methodologies, resulting in increased efficiency and reduced cost.
- Established effective communication among team members for enhanced collaboration and successful project completion.
- Mentored junior team members in project management best practices to enhance their skills and contribute to better overall performance.
- Improved cash flow by streamlining the accounts receivable process and implementing effective collection strategies.
- Reduced overdue balances by consistently monitoring customer accounts and initiating timely followups.
- Assisted in month-end closing procedures, contributing to efficient financial management for the organization.
- Increased accuracy in reconciliations by diligently reviewing bank statements and resolving discrepancies promptly.
- Minimized losses from bad debts through proactive monitoring of high-risk accounts and decisive action on potential writeoffs.
- Maintained a healthy aging portfolio, prioritizing collections efforts based on account balance levels and days past due status.
- Monitored accounts to verify compliance with payment terms and schedules.
- Developed and maintained positive relationships with clients to maximize collections.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
Appeals Manager
Westerkamp Group, LLC
08.2021 - Current
- Enhanced appeal resolution rates by thoroughly reviewing and analyzing case documentation.
- Streamlined appeals process for increased efficiency through consistent tracking and monitoring of cases.
- Collaborated with cross-functional teams, resulting in improved communication and quicker resolutions.
- Maintained comprehensive knowledge of regulatory guidelines to ensure compliance within the appeals department.
- Developed strategic action plans to address identified issues, leading to a reduction in appeals backlog.
- Provided exceptional customer service by promptly responding to inquiries from appellants and other stakeholders.
- Organized and managed appeals caseloads, prioritizing high-priority cases for timely resolution.
- Assisted in the development of training materials, contributing to the improvement of team performance and expertise.
- Participated in regular meetings with management to provide updates on case status and discuss potential improvements in processes.
- Coordinated with medical professionals and subject matter experts for case reviews, obtaining necessary clarification for accurate decisionmaking.
- Ensured confidentiality of sensitive information by following strict security protocols throughout the appeals process.
- Provided support during peak periods by assisting other departments with workload overflow; demonstrating adaptability.
- Developed strong working relationships with internal and external stakeholders, fostering a collaborative environment for efficient resolution of appeals.
- Created, composed and maintained appeal response templates.
- Developed appeals functions, policies and procedures and documentation.
- Acted as a departmental resource on appeals matters.
Director of Operations
Westerkamp Group, LLC
12.2011 - 08.2021
- Improved operational efficiency by streamlining processes and implementing innovative solutions.
- Led cross-functional teams for successful completion of projects, resulting in increased productivity.
- Developed and executed strategic plans to achieve organizational goals and drive sustainable growth.
- Managed budgets and resources, optimizing allocation for maximum impact on business objectives.
- Enhanced employee engagement by developing training programs, fostering a collaborative culture, and promoting professional development opportunities.
- Conducted regular performance reviews to assess team progress, providing constructive feedback and guidance for continuous improvement.
- Spearheaded change management initiatives that facilitated organizational transformations while minimizing disruption to ongoing operations.
- Oversaw day-to-day production activities in accordance with business objectives.
- Oversaw successful implementation of operational strategies and policies to drive organizational growth and productivity.
- Collaborated with senior management to develop and execute long-term corporate goals and objectives.
- Mentored and coached team members to foster productive and engaging work environment.
Revenue Cycle Manager
The Outsource Group (PNIH Merge)
12.2007 - 12.2011
- Improved revenue cycle efficiency by streamlining processes and implementing best practices.
- Reduced accounts receivable days outstanding, optimizing billing and collections efforts.
- Managed cross-functional teams to improve overall revenue cycle operations.
- Increased cash flow through timely resolution of payer denials and underpayments.
- Established strong relationships with payers, improving communication and resolving disputes more effectively.
- Implemented process improvements, ensuring accurate charge capture and coding compliance.
- Provided staff training on revenue cycle management best practices, increasing productivity across the department.
- Conducted regular audits to identify areas for improvement in the revenue cycle process.
- Streamlined workflows to minimize claim rejections and maximize reimbursement rates from insurance providers.
Claims Analyst
Productivity Network Innovations Healthcare
05.2000 - 12.2007
- Reduced claims processing time by implementing efficient analytical techniques and strategies.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Streamlined workflow processes for improved efficiency and reduced claim resolution times.
- Collaborated with cross-functional teams to develop best practices for claim handling procedures.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Provided exceptional customer service by promptly addressing inquiries from policyholders, agents, and other stakeholders regarding the status of their claims.
- Mentored junior team members, sharing expertise in claims analysis techniques and fostering professional growth within the department.
- Identified trends in claim patterns, providing actionable insights for process improvements and risk mitigation strategies.
- Developed comprehensive reports for management review, highlighting key metrics related to claim volume, processing times, and settlement amounts.
- Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Identified key areas not performing well and implemented effective, new processes.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Education
Bachelor of Science - Health Administration
University of Phoenix
Tempe, AZ10.2013
Skills
- Insurance Policy Knowledge
- Policy Interpretation
- Adaptability
- Decision Making
- Project Management
- Effective Communication
- Quality Assurance
- Analytical Thinking
Timeline
Project Manager
Westerkamp Group, LLC
08.2021 - Current
Appeals Manager
Westerkamp Group, LLC
08.2021 - Current
Director of Operations
Westerkamp Group, LLC
12.2011 - 08.2021
Revenue Cycle Manager
The Outsource Group (PNIH Merge)
12.2007 - 12.2011
Claims Analyst
Productivity Network Innovations Healthcare
05.2000 - 12.2007
Claims Supervisor
Productivity Network Innovations
Bachelor of Science - Health Administration
University of Phoenix
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