Occupation Safety Worker's Compensation Short/Long Term Disability

Sara V. Kruser

**** * ***** ****** ****** City, KS 66109

563-***-**** ***********@*****.***

Summary

Highly motivated professional with a diverse background including LTC and

Behavioral direct care, customer service, occupational safety, claims

management as well as supervision, training and compliance auditing.

Strong verbal, listening and writing skills. Comfortable interacting with

all levels of the organization and public. Able to negotiate and problem

solve quickly, accurately and efficiently. Adept at multi-tasking to

achieve individual and team goals.

DataFile Technologies Aug. 13 2012 - Present ROI/HIPAA Account

Manager

. Continued development and enhancement of company procedures and

services.

. Implementation of new client accounts while continually analyzing the

service level agreement to ensure it meets the clients servicing needs

or demands.

. Analysis and reporting of assigned clients to ensure we are meeting

our contractual obligations on all assigned accounts

. Manage accounts receivable in regards to client, requester and patient

collection attempts when invoices are delinquent.

. Training of new and experienced Account Representatives in EMR

environments as well as procedural changes.

. Continual auditing of Account Representatives to ensure HIPAA

compliancy, contractual obligations are met for each assigned client

and to recognize trends for further training needed in servicing the

accounts or streamlining workflow.

. Responsible to foresee issues before they arise so they can be

proactively addressed to ensure continued customer service is given to

clients, requesters and patients alike.

. Management of Account Representatives and other employees as required

by business needs.

. In continual contact with Clinic Administrators regarding

negotiations, contract amendments, servicing decisions, and any

unforeseen communication regarding servicing or IT issues that may

arise.

Packer's Sanitation Oct. 2011 to July 2012 WC/Safety Manager

. Corporate Worker's Compensation Manager, contract sanitation company

for food and meat processing plants, managing a team of 20+ Tech

Service Managers in the field.

. Build and manage WC cases to ensure all required state documents were

supplied within specified timeframes after an injury had occurred.

. Overseen accident and near-miss investigations. Required pictures of

the area and descriptive summary of the incident.

. Managed and tracked safety violations so additional training could be

administered or employment terminated.

. Over seen corrective actions and ensured implementation or additional

training did take place.

. Provided appropriate documentation to TPA for reporting purposes.

. Determines need for outside vendors, surveillance and/or independent

medical evaluations as required and sought advice from director when

warranted.

. Negotiated settlement of appropriate claims within designated

authority level.

. Designed safety training for all levels of employees, Tech Service

managers and sanitations workers alike.

. Supports the organization's quality and safety program(s).

. Overseen drug screening after an occupational injury or suspicion of

use.

. Develop and maintain SOP to ensure workflows were efficient and

effective.

. Assist with determining the need for changes in safety protocols from

TPA injury reporting.

. Maintain weekly Excel report on 300+ plants in relation to the

injuries that occurred.

. Maintain SharePoint for Tech Services Dept.

. Maintain OSHA 300 logs.

Sedgwick CMS May. 2006 to Oct. 2011 Claims Manager

. Analyzed and/or investigated assigned claims to determine if benefits

were due based on the client's disability program.

. Frequent investigation of medical records to ensure the medical

condition met the definition of disability per the plan document.

. Frequent interviews with claimants to ensure their functional

abilities correlated with the medical information supplied.

. When medical evidence did not correlate with claimant's actual

abilities I would determine the need for outside vendors, surveillance

and/or independent medical evaluations as required and seeks advice

from management, when necessary.

. Provides appropriate documentation to Client for reporting purposes.

. Negotiate settlement of claims within designated authority level.

. Makes claim payments and revisions to benefit amounts to offset SSDI

or WC wages.

. Calculate and collect overpayments.

. Supports the organization's quality program(s).

. Streamline workflows to ensure work in completed efficiently.

. Educate claimants of documentation and contractual requirements to

remain eligible for the company benefit.

. Managed Return to Work programs to ensure disability guidelines were

not exceeded.

. Experience with the California Voluntary Plan, paid and unpaid leaves,

as well as Family Medical Leave Act rules and regulations.

Education 2004 to 2006

Associate in Applied Science Health Information Technologies NICC,

Peosta, Ia.

Courses were as follows:

ICD-9 & CPT Coding Principles of Disease Anatomy & Physiology

Healthcare Reimbursements Medical Terminology Pharmacology Healthcare

Delivery/Information Systems in relation to EHR Legal Aspects of Health

Information HIPAA Regulations Quality Management & Data Processing of

EHR Comparative Records.

Passed Texas Worker's Compensation Licensing Exam July 2013

Computer Experience

Advanced Knowledge of:

Word Excel Powerpoint Outlook Internet

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