SHARI RUTLEDGE
Des Moines
Summary
Technical professional with over 20 years of experience in inventory management. Proven track record of delivering actionable insights and implementing process improvements aligned with business objectives. Strong collaborator focused on achieving results and adapting to evolving requirements.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Payment Integrity Analyst – Non-Clinical
Wellmark BCBS
12.2022 - Current
- Evaluate provider payment claim reports and inquiries daily for reasonableness
- Audit claims to ensure accurate and efficient processing per payment policies.
- Engage directly with provider community, Payment Integrity partners, Medical Directors, and other Wellmark stakeholders
- Act as business resource for creation, development, design, and implementation of payment policies.
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
Claims Services Coordinator
Wellmark BCBS
05.2017 - 12.2022
- Facilitate communication between Wellmark and Claims Vendors to ensure rapid resolution of suspended claims.
- Guarantee vendor delivers client-focused service through prompt adjudication of claims and quality results that fulfill company expectations.
- Led and monitored assigned projects by leader
- Investigate and evaluate business or system processes to verify accuracy
- Served as technical resource and subject matter expert for all business units.
Collaborated as business liaison to enhance interdepartmental communication.
Delivered expertise across organization to address diverse operational challenges. - Coordinated inventory oversight for all vendor-related business lines.
Supervised functions in quality assurance, claims processing, and inquiry processing.
Facilitated guideline updates aimed at enhancing overall process improvements.
Enhanced efficiency across multiple business lines through strategic management. - Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
Senior Claims Specialist
Wellmark BCBS
07.2007 - 05.2017
- Deliver expert assistance and direction to claims examiners
- Enhance and preserve claims examiner relationships via constructive feedback
- Administer side-by-side training sessions and evaluate performance of claim examiners.
- Track aging and generate reports to guarantee claims timeliness.
- Technical resource for resolution of escalated problems, issues, and detailed inquiries.
- Optimized inventory management for prompt claims processing while maintaining high levels of accuracy
- Claims liaison for former claim vendor to optimize workflows for added responsibilities,
- Partnered with leader to manage dedicated team focusing on claims processing and customer service responsibilities.
Education
Bachelor’s degree - Psychology, minor in management
Upper Iowa University-Fayette
Fayette, IA01.2021
Skills
- Analytical reasoning
- Customer-centric
- Effective communication skills
- Personal motivation
Organizational skills
Time management - Research and analysis skills
Critical thinking
Data interpretation
Problem-solving - Teamwork and collaboration
- Team leadership
- Microsoft office
- MS Excel
- Process improvements
- Audit support
- Trend forecasting
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Resolved product issue through consumer testing.
- Supervised team of 13 staff members on the specialty team. Also in the role of the liaison, there was a team of 75 claims examiners that were managed.
- Achieved making the liaison role successful by seeking education on all lines of business that the vendors would be working on. This was a new role to the company and it was very successful and has now been incorporated to other departments within the organization.
Certification
American Health Insurance Plans
CPC
Languages
English
Timeline
Payment Integrity Analyst – Non-Clinical
Wellmark BCBS
12.2022 - Current
Claims Services Coordinator
Wellmark BCBS
05.2017 - 12.2022
Senior Claims Specialist
Wellmark BCBS
07.2007 - 05.2017
Bachelor’s degree - Psychology, minor in management
Upper Iowa University-Fayette
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