Reeva Stelly
Opelousas,La
Summary
Dedicated professional with over 10 years of experience in the medical field, specializing in clerical, administrative, and financial roles. Currently pursuing a Master's Degree in Healthcare Administration at Southern New Hampshire University, complemented by a Bachelor's Degree in Education. Expertise includes customer service in healthcare settings, billing processes, SQL, OnBase, credentialing, and a comprehensive understanding of insurance regulations and HIPAA compliance. Proven ability to assist diverse populations, including the elderly and families, in navigating benefits and programs while effectively adapting to remote work environments.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Senior Claims Analyst
GeauxCare
04.2023 - Current
- My duties are to examine claims, ensure that all claims are ready to be filed with the correct billing codes, contact patients for missing information, help with obtaining benefits, and contact insurance companies for denials and reprocessing. Examining governmental contracts to ensure all standards are up to date.
- Analyzed complex claims data to identify trends and discrepancies, enhancing accuracy in decision-making.
- Led cross-functional teams in resolving high-stakes claims issues, fostering collaboration among departments.
- Developed and implemented streamlined procedures for claims processing, improving overall efficiency and reducing turnaround time.
- Evaluated policy changes to assess potential impacts on claim processing operations, ensuring compliance with regulations.
- Conducted training sessions for staff on new systems and tools, enhancing team proficiency in claims management software.
- Maintained up-to-date knowledge of industry trends and regulatory changes, applying insights to enhance claim processing effectiveness.
Director
Little Saints
07.2021 - 02.2023
- My duties are to implement the curriculum in the classroom setting, make sure all licensing standards are being followed and up to date, and help parents apply for benefits that may apply to them, such as CCAP, Early Steps, B3, and any other related programs. Making sure the kids understand what was taught, and when evaluated, have a clear understanding of the materials that have been taught.
- Developed and implemented strategic initiatives to enhance organizational efficiency and service delivery.
- Mentored staff to foster professional growth and improve team performance.
- Streamlined processes, resulting in improved response times and customer satisfaction.
- Managed budgets effectively to ensure optimal use of resources while maintaining financial stability.
Remote Customer Service Representative
ERC (Enhanced Resource Centers)
11.2020 - 03.2021
- My duties were to reach out to consumers about past debts, set up payment arrangements to satisfy debts that had been previously owed, and notate accounts with payment information or any important information.
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Processed high volumes of customer transactions accurately and efficiently.
- Managed escalated issues, ensuring timely resolution while maintaining positive relationships.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
Teacher
Lafayette Parish School Board
11.2017 - 12.2019
- While working as a teacher, my duties were to annotate lesson plans, implement those lesson plans, implement classroom rules and order, plan appropriate assessments for students, follow student behavior plans, and create a safe and nurturing environment.
- Developed engaging lesson plans to enhance student understanding and participation.
- Implemented differentiated instruction strategies to meet diverse learning needs.
- Collaborated with colleagues to create interdisciplinary curriculum initiatives.
- Coordinated extracurricular activities to promote student engagement and leadership skills.
- Developed strong relationships with students, parents, and colleagues by maintaining open lines of communication and fostering a supportive learning environment.
Billing Specialist
Acadiana Health and Aesthetics
09.2017 - 11.2017
- My duties were to follow up on insurance-rejected claims, correct the mistakes, and refile claims, update and verify patient insurance info, and adjust payments on accounts. Work on aging reports, and notate which accounts were able to be collected on, and which accounts had reached a level of timely filing.
- Processed and reconciled insurance claims to ensure timely payments.
- Managed patient billing inquiries, providing clear explanations and resolving discrepancies.
- Implemented electronic billing systems to enhance efficiency and reduce errors.
- Developed comprehensive reports on billing performance metrics for management review.
- Maintained detailed records of each account''s payment history, providing easy access to information for audit and analysis purposes.
Revenue Recovery Representative
Schumacher Clinical Partners
01.2014 - 01.2017
- My job duties consisted of coordinating insurance benefits, authorization of referrals, processing of referrals, appealing low-paying claims, creating appeal letters to appeal on behalf of the patient, acting as a liaison to billing companies, payers, and other necessary parties;
- Responsible for ensuring the correction of discoveries, maintaining a thorough knowledge of reimbursement procedures and regulations related to assigned projects, and providing feedback to the revenue cycle related to improvement opportunities and appeals.
- Coordinating and performing phone appeals with the insurance company, maintaining up-to-date records on status and any communications with the plan or patient, providing general support in reviewing, researching, investigating, negotiating, and resolving all types of appeals and grievances, and maintaining assigned projects until completion or until they can be handed off.
- Reviewing reimbursement data for the accuracy of payments and adjustments, maintaining a high level of accuracy in follow-up, while maintaining thorough and concise notes documenting communication with all involved parties.
- Providing input and recommending improvements to existing projects in an effort to maximize reimbursement, improve appeal efficiency, and reduce appeal aging, while providing guidance and/or assisting billing representatives in the accounts receivable follow-up process, and analyzing and identifying trends for appeals and grievances.
- Analyzed complex billing discrepancies to recover lost revenue efficiently.
Authorization Coordinator
Advantage Resourcing North America
10.2014 - 08.2016
- Clearing AR accounts, go through a backlog of authorizations that were never completed, and obtain the information needed to get the claim authorized and processed for payment.
- Coordinated authorization processes to ensure compliance with organizational standards.
- Improved patient care by efficiently coordinating authorizations for medical procedures and treatment plans.
- Facilitated timely renewals of ongoing authorizations by closely monitoring expiration dates and initiating renewal processes proactively.
- Reviewed authorizations from payer to determine approved or denied items.
Customer Service Rep
ATT
01.2009 - 01.2011
- My duties were to answer inbound calls that were in queue, look up and verify customers' accounts to ensure that I was speaking with the correct and authorized account holder. Also, to process payments and credits, explain bills and charges. Process new orders.
- Resolved customer inquiries using advanced problem-solving techniques and product knowledge.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
Insurance Coordinator
Children's Clinic of Southwest
01.2007 - 01.2010
- My duties were to answer inbound calls from patients who needed appointments scheduled, find appropriate appointment times, block out doctors' schedules, and upload documentation.
- Coordinated insurance verification processes to ensure timely patient coverage and service delivery.
- Managed claims submissions and follow-ups, resolving discrepancies to enhance reimbursement rates.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Filed and tracked insurance claims and communicated claims status to patients.
- Obtained prior authorization and precertification for outpatient procedures.
- Negotiated with insurance carriers to secure competitive rates for clients, enhancing customer satisfaction.
Education
Master's Degree - Healthcare Administration
Southern New Hampshire University
Manchester, NH11.2025
Bachelor - Early Childhood Education
Kaplan University-Davenport Campus
Davenport, IA01.2018
High School Diploma -
Port Barre High School
Port Barre, LA01.2005
Skills
- Excel proficiency
- Talent acquisition
- Data acquisition
- Statistical analysis proficiency
- Solid foundation in technical computer applications
- Critical analysis of documentation
- HIPAA compliance knowledge
- Clinical administrative experience
- Data analysis
- Medical records
- Proficient in EMR software
- Medical terminology
- SQL data analysis
- Proficient in ICD-10 classification
- Information tracking systems
- Claims processing efficiency
- Data entry
- Training & development
- Accounts receivable
- Clerical experience
- Organizational skills
- Administrative experience
- Project management
- Critical thinking and analysis
Certification
CPR
Timeline
Senior Claims Analyst
GeauxCare
04.2023 - Current
Director
Little Saints
07.2021 - 02.2023
Remote Customer Service Representative
ERC (Enhanced Resource Centers)
11.2020 - 03.2021
Teacher
Lafayette Parish School Board
11.2017 - 12.2019
Billing Specialist
Acadiana Health and Aesthetics
09.2017 - 11.2017
Authorization Coordinator
Advantage Resourcing North America
10.2014 - 08.2016
Revenue Recovery Representative
Schumacher Clinical Partners
01.2014 - 01.2017
Customer Service Rep
ATT
01.2009 - 01.2011
Insurance Coordinator
Children's Clinic of Southwest
01.2007 - 01.2010
Bachelor - Early Childhood Education
Kaplan University-Davenport Campus
Master's Degree - Healthcare Administration
Southern New Hampshire University
High School Diploma -
Port Barre High School