Rebecca Rushing
Greenback
Summary
Organized Insurance Claims professional offering expertise in investigation, litigation and settlements. Proficient in executing claims transactions and applying settlement protocols to foster timely, fair and accurate claims processing. Track record of superior performance in tea, leadership roles.
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.
Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
27
27
years of professional experience
Work History
Claims Examiner
Office of the Staff Judge Advocate
Fort Sill
08.2023 - Current
- Responsible for receiving, examining, investigating, and evaluating claims under Army Regulation 27-20, Chapters, 3, 4, 5, 6, 9 and tort claims under Chapter 12 for the Fort Sill area of responsibility, which includes all of Oklahoma and Arkansas.
- Includes claims arising from activities of military and civilian personnel incident to non-combat activities of the Army, claims based on negligent acts or omissions of military or civilian personnel under the Federal Tort Claims Act, Military Claims Act, and National Guard Claims Act, claims incident to the use of Government vehicles (Non-scope), claims under the UCMJ, Article 139, and claims in favor of the Government for property damage sustained by the Army and NAF activities.
- Reviews submitted claims, investigates to develop necessary factual information, makes determinations as to the liability, prudence, reasonableness; prepares memoranda of opinion, assembles case files, and initiates claims in favor of the Government.
- Provides information to individuals and Fort Sill agencies regarding claims and potential claims issues.
- Arranges payments of all claims settled within Fort Sill’s adjudication authority.
- Drafts denial memoranda and denial letters to claimants for review by the CJA and approval and signature by the SJA for all claims found not compensable.
- Monitors the progress of Article 139 claims.
- Drafts demand letters to insurance carriers for collection of property damage claims.
- Notify witnesses and experts of the necessity of preserving evidence and obtain litigation hold acknowledgments from all.
- Continually monitoring military police blotters and reports, newspapers, and local media to identify potential claims including affirmative claims and Article 139 claims, as well as keeping in close contact with National Guard and Reserve personnel, other military installations within our area of jurisdiction, MWR, AAFES, DPW, other SJA personnel, and military police personnel.
- Attend Reynolds Army Health Clinic’s Risk Management meetings regularly and keep in close contact with the RAHC Risk Manager to identify potential medical malpractice claims and preserve medical records and other evidence.
- Analysis and research of all submitted claims.
- Processes bi-weekly civilian timecards for payment of OSJA civilian employees.
- Maintains records for audit purposes to include leave forms, overtime approvals, military leave, etc.
Patient Advocate
Reynolds Army Health Clinic
Fort Sill
04.2023 - 08.2023
- Serves as the Patient Advocate/Representative (PA) for Reynolds Army Health Clinic(RAHC) in support of the Quality and Safety Division (QSD) and as such functions as the official point of contact (POC) for all related problems or assistance requirements for the full range of authorized beneficiaries.
- Acts as liaison between patients, RAHC staff, the TRICARE Contractor, and others within the community as it relates to patient benefits, healthcare sources, rights and advocacy.
- Champion for Rights and Responsibilities and the Joint Commission (TJC) Functional Management Team (FMT).
- Incumbent is responsible to the Deputy to the Commander for Quality and Safety (DtCQS) who is then responsible to the Commander.
- Plans and implements the patient advocate/representative program.
- Establishes internal procedures and mechanisms to receive, consider, and respond to patient inquiries, complaints, and requests for assistance.
- Documents and reports the results of patient interviews to include satisfaction with and/or obstacles to delivery of health care service.
- Continuously monitor program activities, reports, coordination with professional staff, patient interviews, etc; identifies potential problem areas and trends of patient complaints or patients’ concept of complaints requiring further study.
- Conducts studies and makes recommendations to management concerning impact of policies and procedures affecting health care delivery and possible changes.
- Keeps appropriate documentation and statistics necessary for program evaluation and planning.
- Prepares a variety of special and recurring reports.
- Counsels beneficiaries regarding the TRICARE health care delivery program and other related issues such as TRICARE Prime Remote, TRICARE for Life (TFL), Dental Programs, Express Scripts, and other local, state, and federal programs to include costs to and responsibilities of the beneficiary, covered health care services, services excluded, claims process and enrollment, etc.
- Explains appeals and grievance procedures, advises on their appropriate use and disseminates current information on TRICARE regulations and policies to beneficiaries when the need arises.
- Collects and enters data/information into automated computer systems.
- Maintains a formal documentation process for tracking actions and problem resolution.
- Compiles monthly statistics on concerns, compliments, patient assists, etc.
- Recommends monthly recipients of recognition awards.
- Compose correspondence and answer questions regarding reports and overall system capabilities.
- Develops spreadsheets, reports, and charts pertaining to functional areas of expertise.
- Makes suggestions for development of marketing/beneficiary education efforts to improve understanding of issues based on information gleaned from reports.
- Joint Commission compliance, HCFA guidelines, also participating with groups representing patient concerns/attitudes.
Patient Advocate Assistant
Bayne-Jones Army Community Hospital
Fort Polk
09.2021 - 03.2023
- Serves as point of contact for patients with request for assistance and complaints concerning medical treatment needed and/or treatment previously rendered.
- Makes determination of eligibility to obtain benefits or privileges at this medical treatment facility (MTF) based on Army Regulations and command directives (e.g., TRICARE Prime, space availability).
- Furnishes information and assistance to patients based on personal, written, or telephone inquiries concerning both inpatient and outpatient care.
- Gathers necessary, information pertaining to problem to determine appropriate response and course of action to be taken.
- Explains availability of these resources and instructs and assists patients on proper procedure to obtain needed medical care.
- Explains, clarifies hospital policy regarding eligibility for medical care at this MTF and which services are offered.
- Provides advice concerning obtaining medical care elsewhere when not eligible for care at this MTF.
- Reviews questionable eligibility for care, and forwards to the Patient Advocate.
- Serves as an official point of contact between patients and the Commander.
- Immediately advises the Patient Advocate and Commander of any serious problems, particularly those which may have potential for litigation.
- Files original forms as required.
- Initiates, prepares, and provides assistance in preparation of reports related to written complaints.
Legal Assistant
Office of the Staff Judge Advocate
Fort Sill
10.2019 - 09.2021
- This position is located in the Office of the Staff Judge Advocate (SJA), of the Joint Force Headquarters (State).
- This office provides legal assistance/advice to The Staff Judge Advocate and other OSJA personnel.
- Provides technical and procedural guidance and support to unit commanders and legal personnel as required in the accomplishment of a variety of administrative and clerical duties necessary for effective and efficient operation of the program.
- Provides technical and procedural guidance and legal assistance.
- Provides support to administer courts-martial, non-judicial punishment, administrative boards and other assorted actions.
- Performs limited research to identify factual and legal issues in order to provide relevant evidence to prepare summaries of precedent cases, interviews, testimony, depositions, and related case material for use by the attorney.
- Must choose from references that may include but are not limited to: Department of Defense (DoD), Departments of the Army and Air Force, and National Guard Bureau regulations; Uniformed Code of Military Justice (UCMJ); State Code; local policies and directives; as well as online Internet references.
- Prepares and organizes trial exhibits and validates citations and legal references on prepared legal documents.
- Maintains a variety of files, records, forms, and retires same; prepares special and recurring reports; receives and distributes incoming mail and composes replies to routine military and nonmilitary correspondence; reviews incoming documents for completeness and correctness and returns to originator those that require corrections; maintains time and attendance records; maintains suspense records of items requiring action or replies and notifies staff members when action is required; makes travel arrangements for staff members and forwards travel vouchers for reimbursement; requisitions office supplies and office equipment repairs; and keeps appointment calendar for Judge Advocate and staff members.
- Conduct light studies and analysis sufficient to evaluate assigned administrative programs and make recommendations for improved program effectiveness.
- Coordinate actions for CG signature to include recommendations to modify procedures.
EFMP Coordinator
Reynolds Army Health Clinic
Fort Sill
11.2016 - 10.2019
- Plans, coordinates and executes or oversees the administrative requirements for the EFMP in the Region.
- Instructs SRMC MTF staff and other concerned parties or agencies on program policy, operations, and procedures.
- Serves as the Post technical authority on EFMP Overseas Screening/Family Member Travel Screening for active-duty sponsors and their Family members who live in the Southwest Region surrounding Fort Sill.
- Identify resources and services for Active-Duty family members who have physical, developmental, emotional or intellectual disabilities or illness.
- Provides information on eligibility and procedures of a health care program that offers services for clients who have physical, developmental, emotional or intellectual handicaps.
- Reviews documents for enrollment into the program for accuracy and completeness; and maintains health records in an automated system.
- Coordinates overseas screening process with the headquarters/Installation Military Personnel Reassignments offices and the RMC/MEDCEN/MTF offices throughout the world, ensuring procedures follow DOD and Army guidance.
- Communicates with supervisor when denial of family travel may alter outdated EFMP enrollment information.
- Receives and reviews EFMP evaluation packages from care providers for accuracy, completeness and internal consistency.
- Inputs data into PERNET from the MTFs supported by Fort Sill.
- Provided clear and concise information to target demographic.
- Managed the entire EFMP program within the organization.
- Regularly used regulations to interpret and apply relevant guidelines to the program to ensure appropriate course of action was being followed.
- Knowledge of various office automation software programs, tool, and techniques to support office operations and produce a variety of documents such as invitations, place cards, menus, itineraries, letters, reports, spreadsheets, databases, and graphs was required.
- Provides program information and guidelines for enrollment to service members and Family members, hospital staff, and health care providers.
- Conducts preliminary review of Exceptional Family Member cases to determine eligibility for enrollment.
- Regularly interacted with diverse audience such as military members, family, leadership, and outside resources to facilitate EFMP enrollment/overseas clearance.
- Answers questions and concerns regarding any medical or educational resources.
- Resolves questions and inconsistencies by making follow-up contacts with Family members.
- Assists sponsors and Family members in completing program enrollment forms and other documents for enrollment in EFMP.
Patient Advocate
Cardon Outreach
Lawton
05.2016 - 11.2016
Government Enrollment Specialist II
Hawaii Medical Services Association (HMSA)
Honolulu
03.2013 - 05.2014
Government Insurance Liaison
Samaritan Medical Center
Watertown
03.2011 - 11.2011
Health Services Management Technician
Illinois Air National Guard- 126th ARW
Scott AFB
08.2001 - 02.2009
Health Services Management Technician
United States Air Force
Randolph AFB
11.1998 - 07.2001
Education
Master’s degree - Healthcare Law
University of Oklahoma, College of Law
Norman, United Statesbachelor’s degree - Business, Healthcare Management
American InterContinental University
Hoffman Estates, IL, United StatesParalegal Certificate -
Kansas State University Global Campus
High School or equivalent - High School Diploma
Valley View High School
Germantown, OH, United StatesSkills
- Health care delivery systems management
- Investigative techniques
- Analytical techniques
- Fact-finding techniques
- Oral communication
- Written communication
- Patient advocacy
- Program requirements knowledge
- Spelling and grammar proficiency
- Record maintenance
- Office filing system
- Report preparation
- Computer operation
- Word processing software
- MS-Office software
- Power Point
- Excel
- Medical automated systems
- Customer service fundamentals
- Relationship building
- Freedom of Information Act knowledge
- Privacy Act knowledge
- HIPAA knowledge
- Claims evaluation
- Customer support
- Conflict resolution
- Legal research
- Effective communication
- Attention to detail
- Problem solving
- Data analysis
- Team collaboration
- Verbal communication
- Data verification
- Healthcare procedures
- Claims processing
- Microsoft Office Suite
- Investigative skills
- Task prioritization
- Adaptability and flexibility
- Customer service and support
- Problem-solving abilities
- Legal documentation and reporting
- Team Training
- Professional demeanor
- Professionalism
- Analytical thinking
- Active listening
- Negotiation and mediation
- Complex Problem-solving
- Time management
- Database management
- Verify data
- Continuous improvement
- Multitasking
- Communication skills
- Benefits review
Day Phone
315-777-1828
Timeline
Claims Examiner
Office of the Staff Judge Advocate
08.2023 - Current
Patient Advocate
Reynolds Army Health Clinic
04.2023 - 08.2023
Patient Advocate Assistant
Bayne-Jones Army Community Hospital
09.2021 - 03.2023
Legal Assistant
Office of the Staff Judge Advocate
10.2019 - 09.2021
EFMP Coordinator
Reynolds Army Health Clinic
11.2016 - 10.2019
Patient Advocate
Cardon Outreach
05.2016 - 11.2016
Government Enrollment Specialist II
Hawaii Medical Services Association (HMSA)
03.2013 - 05.2014
Government Insurance Liaison
Samaritan Medical Center
03.2011 - 11.2011
Health Services Management Technician
Illinois Air National Guard- 126th ARW
08.2001 - 02.2009
Health Services Management Technician
United States Air Force
11.1998 - 07.2001
Master’s degree - Healthcare Law
University of Oklahoma, College of Law
bachelor’s degree - Business, Healthcare Management
American InterContinental University
Paralegal Certificate -
Kansas State University Global Campus
High School or equivalent - High School Diploma
Valley View High School