Stephanie Rainey
Richmond,TX
Summary
Analyst specializing in regulatory compliance and claims processing. Expertise in identifying discrepancies and implementing solutions that enhance operational efficiency and reduce fraud risk. Extensive experience in analyzing complex data and improving processes, leading to measurable results. Strong focus on delivering high-quality outcomes and facilitating effective communication among stakeholders.
Overview
23
23
years of professional experience
Work History
Teacher, English
Houston Independent School Distict
Houston, TX
08.2025 - 09.2025
- Assessed student progress through regular quizzes and assignments for feedback.
- Communicated effectively with parents about student performance and behavior.
- Utilized technology tools for lesson delivery and student engagement enhancements.
- Participated in professional development workshops related to teaching methods or curriculum changes.
- Collaborated with colleagues to plan lessons that integrate various subject areas into a cohesive unit of study.
- Tested students' comprehension of subject matter through quizzes, tests and projects.
Configuration Oversight Analyst
Molina Healthcare
Long Beach , CA
04.2023 - 07.2025
- Communicated with clients to clarify information and resolve claim issues.
- Performed detailed analysis of claim data to identify trends or inaccuracies in the system.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Audited company's legal documents to verify compliant policies and procedures.
- Oversaw quality control to identify inconsistencies and malfunctions.
- Created plans to propose solutions to problems related to efficiency, costs or profits.
- Maintained accurate records of all data collected during analysis processes.
- Assisted in the implementation of process improvement initiatives.
- Analyzed claim data to identify discrepancies and potential fraud.
- Documented findings and prepared reports for management review.
- Utilized claims management software to track audit progress and results.
- Collaborated with team members to ensure timely completion of audit projects.
- Identified trends in fraudulent or incorrect claims payments through analysis of audit results.
- Conducted system analysis and testing to identify and resolve technical issues or inefficiencies.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Analyzed Medicaid claims for accuracy and compliance with regulations.
Claims Benefit Specialist
Catalyst Solutions (Aetna MCO)
Greenwood Village, Colorado
10.2021 - 04.2023
- Processed claims to ensure adherence to company policies and regulations.
- Addressed discrepancies in claims by coordinating with internal departments effectively.
- Collaborated with management personnel to develop new processes for evaluating claims more efficiently.
- Investigated potential fraud cases involving false claims submitted by customers.
- Precisely calculated refunds, premiums, and adjustments.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Assisted in training new staff on Medicaid processes and systems.
Claims Benefits Specialist
Manhattan Life Insurance
Houston, TX
10.2020 - 10.2021
- Prioritized and organized tasks to efficiently accomplish service goals.
- Utilized various software and tools to streamline processes and optimize performance.
- Conducted comprehensive research and data analysis to support strategic planning and informed decision-making.
- Evaluated supporting documentation to determine eligibility for claims approval.
- Reviewed health insurance claims for accuracy and compliance with policies.
- Applied knowledge of coding systems such as ICD-10, CPT, and HCPCS to accurately process claims.
Systems Analyst-Epic
Methodist Physicians Organization
Houston, TX
07.2017 - 08.2017
- Assisted in the implementation of software solutions across departments.
- Provided support for end users in troubleshooting system issues.
- Worked closely with IT teams to ensure proper integration between systems platforms.
- Provided training sessions for end users on how best utilize the company's systems.
Claims Educator/Auditor
Texas Children's Health Plan
Bellaire, TX
07.2007 - 07.2017
- Updated training programs based on industry trends and regulatory changes.
- Implemented best practices for claims management and dispute resolution training.
- Tracked changes within the industry that may impact current training strategies.
- Assisted in training new staff on Medicaid processes and systems.
- Identified potential fraudulent claims and conducted detailed investigations.
- Documented claim actions and decisions thoroughly for audit purposes.
Revenue Cycle Business Associate II
Christus Health
Houston, TX
06.2006 - 07.2007
- Conducted audits on accounts receivable to ensure timely collections.
- Reviewed claims for accuracy and compliance with regulations.
- Analyzed complex billing issues, identified root causes, and developed solutions to improve revenue cycle operations.
- Prepared data analysis regarding charge entry errors, underpayments, denials, utilizing various reporting tools such as Excel spreadsheets or Access databases.
- Submitted appeals to insurance carriers when denied claims were received due to incorrect coding or insufficient documentation.
Senior Reimbursement Analyst
Healix Infusion Therapy
Sugar Land, TX
05.2002 - 01.2006
- Reviewed patient accounts to ensure compliance with reimbursement policies.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Precisely calculated refunds, premiums, and adjustments.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Advised supervisors and clinicians of billing deficiencies to support charge capture.
- Investigated unresolved issues related to claim denials or rejections, payment discrepancies, coding issues, and other billing errors.
Education
MBA - Finance
Louisiana State University, Shreveport,
Shreveport, LA03-2027
BBA - Healthcare Administration
Texas A&M University - Victoria
Victoria, TX12-2024
Associate of Arts - Business
Houston Community College
Houston, TX12-2014
Skills
- Data analysis and financial reporting
- Claims processing and trend analysis
- Project management
- Effective communication
- Process improvement
- Team collaboration
- Regulatory compliance
- Medical coding and records review
- Problem resolution
- Financial analysis
- Time management and prioritization
- Medical terminology
- Multitasking Abilities
- Training development
- Microsoft, Excel, Word and Power Point proficient
Timeline
Teacher, English
Houston Independent School Distict
08.2025 - 09.2025
Configuration Oversight Analyst
Molina Healthcare
04.2023 - 07.2025
Claims Benefit Specialist
Catalyst Solutions (Aetna MCO)
10.2021 - 04.2023
Claims Benefits Specialist
Manhattan Life Insurance
10.2020 - 10.2021
Systems Analyst-Epic
Methodist Physicians Organization
07.2017 - 08.2017
Claims Educator/Auditor
Texas Children's Health Plan
07.2007 - 07.2017
Revenue Cycle Business Associate II
Christus Health
06.2006 - 07.2007
Senior Reimbursement Analyst
Healix Infusion Therapy
05.2002 - 01.2006
MBA - Finance
Louisiana State University, Shreveport,
BBA - Healthcare Administration
Texas A&M University - Victoria
Associate of Arts - Business
Houston Community College