Rita Scott
Crawfordville,FL
Overview
17
17
years of professional experience
Work History
Provider Data Management Analyst I
Wellcare
10.2019 - Current
- Analyze data trends to inform strategic decision- making processes
- Developed and maintained comprehensive databases for accurate data management
- Gather and interpret business requirements and monitor data trends to proactively identify issue handle multiple projects and timelines effectively and communicate risks and issues to manage regularly to actively achieve a 98% accuracy
Government Collection Specialist
Genesis Healthcare
01.2017 - 09.2019
- Review insurance claims to assess their validity, completeness, and adherence to policy terms and conditions.
- Collect, organize, and analyze relevant documentation, such as medical records, accident reports, and policy information.
- Ensure that claims processing aligns with the company's insurance policies and relevant regulatory requirements.
- Conduct investigations, when necessary, which may include speaking with claimants, witnesses, and collaborating with field experts.
- Analyze policy coverage to determine the extent of liability and benefits payable to claimants.
- Evaluate the extent of loss or damage and determine the appropriate settlement amount.
- Communicate with claimants and policyholders to explain the claims process, request additional information, and provide status updates.
- Make recommendations for claims approval, denial, or negotiation of settlements, and ensure timely processing.
- Maintain accurate and organized claim files and records.
- Stay updated on industry regulations and maintain compliance with legal requirements.
- Strive for high efficiency and accuracy in claims processing, minimizing errors and delays.
- Generate and submit regular reports on claims processing status
- Perform other duties as assigned.
Data Analyst
Coram Healthcare
08.2011 - 09.2016
- Contact Payor regarding claims issues, problems or failure to pay.
- Submit supplemental information if required. Re-submit claim/ bills in response to billing errors.
- Trained associated on secondary billing. Emailed information for employee who inquired out leave.
- Worked with HR to make sure the information aligned with compliance with relevant laws.
Customer Service Supervisor
Kmart
01.2009 - 05.2011
- Completely Trained and assisted Cashiers
- Money count in cash drawers before and after shifts
- Handled end-of-day safe drops
Education
National Certified Insurance Coding Specialist -
NCICS
Marietta, GA12.2005
Skills
Microsoft Office
Critical Thinking
Data Entry
Organization and attention to detail
Excellent written and verbal communication skills
Timeline
Provider Data Management Analyst I
Wellcare
10.2019 - Current
Government Collection Specialist
Genesis Healthcare
01.2017 - 09.2019
Data Analyst
Coram Healthcare
08.2011 - 09.2016
Customer Service Supervisor
Kmart
01.2009 - 05.2011
National Certified Insurance Coding Specialist -
NCICS