Manager

Tracey R. Rucker M.B. A.

513-***-**** ****************@*****.***

EDUCATION

Indiana Wesleyan University, Ohio

Degree: Masters in Business Administration, December 2012

Wilmington College, Ohio

Degree: Bachelors of Business, December 2009

PROFESSIONAL ACHIEVEMENTS

Leadership/Supervisory

Proven leadership and supervisory experience with ability to lead multiple projects/teams simultaneously

Solutions-driven manager and trainer who relates well with diverse populations at all levels.

Strong organizational and analytic abilities applied to achieve desired goals, objectives, and results.

Lead over two Cigna Health Care Ohio regions provider service department.

Personal traits: professional; common sense; adaptability; focused; skilled.

Technically functional in the use of Microsoft Office Word, Excel, PowerPoint, Outlook, QNXT, CPS, and MCO claims adjudication systems.

Training and Development

Experience working within a TPA atmosphere

Proven experience in the management of Health Insurance claims

Excellent interpersonal, communications and planning skills

Strong customer service focus and skills

Hired, trained, and coached team members

implemented policies and procedures

Generated, analyzed, and distributed monthly performance reports

Manage daily team processes, approved schedules, implement training initiatives, and review performance.

Reduced aged inventory and met performance goals by creating strategic claims inventory management and reporting processes.

Created a production standards metrics which streamlined measurements and reporting.

Resolved client issues in coordination with CMS policies and Regulations

Conduct error trend analysis to identify trying opportunities.

Managed claims appeal process and Department of Insurance complaints

PROFESSIONAL EXPERIENCE

Tristate Benefits Solutions (TriHealth) 2013- Present

Claims Manager

Oversee multiple areas of a mid-size claims adjudication department including, claims analysis, data entry, incoming and outgoing mail, front end scanning, customer service, eligibility, quality, health data analyst.

Coordinated claims department operation, handling claims adjudication for 23 clients.

Manage daily team processes, approve schedules, implement training and review performance.

Implemented a Customer Service Unit, improving accountability and service among clients and vendors.

Increased productivity among, the claims analysts, doubling claims processing within a 4 month time period.

Implemented an audit department to ensure accurate handling of claims

Implemented training so that Claims Analyst is able to transition to new client accounts.

Restructured the mail room to become more functional and relieved a 9 month backlog on scanned claims within a 6 month turnaround time.

Perform Accounts Payable functions for the department as a whole.

Hire, train and recruit candidates for open positions.

Medical Mutual, Cincinnati, Ohio 2012 - 2013

Provider Contracting Representative

• Negotiates standard & non-standard contracts

• Compiles and analyzes data to support contracting negotiations and/or compliance

• participate and/or take the lead in internal or external projects

• Demonstrate a thorough understanding of assigned contracting region by developing relationships with office personnel. Explain the process of contract provisions to internal/external customers. Act as team lead for coordinators

• Identifies program/system enhancements to reduce/minimize issues

Mercy Health, Cincinnati, Ohio 2010-2012

Senior Revenue Accounts Receivable Specialist

Acts as subject matter expert in Medicare and Medicaid

Review denials via systems for inpatient and outpatient due to no authorization and medical necessity.

Write appeal letters for no authorization and medical necessity

Work collaboratively with internal partners to review and work accounts for coding and charge master compliance issues.

United Medical Resources, Inc., (TPA) Cincinnati, Ohio 2007-2010

Appeal Coordinator

Review Complaints, Appeals & Grievances initiated by the Members.

Conduct detailed research of adverse determinations rendered by the Claims and/or Medical Management Department.

Data collection analysis and reporting of member issues/disputes via internal and external systems.

Provide education to Member, Providers and internal staff on appeals process.

Medical Benefits Administrator 2005-2007

Accurately and efficiently process medical, disability, and hospital claims.

Conduct claim adjustments, check voids, refunds, stop payments.

Liberty Mutual, Cincinnati, Ohio

Sr. Customer Service Representative 2004-2005

Identify, research and follow-up on automotive accidents/property losses from customers and claimants through telephone, internet and written reports.

Assists with appraisals/estimates, communicate results of finding to customers, policyholders, claimants and attorneys.

Work collaboratively with internal and external partners to assess liability/compensability, negotiate settlements.

Alliance Partners, Cincinnati, Ohio

Credentials Verification Specialist 2002-2003

Prepare and run National Provider Data Basic queries.

Liaison with Network Development Departments and Health Alliance Medical Staff Offices on assigned applications

Creating and maintaining credentialing files for new providers and allied health providers.

Western Southern Life, Cincinnati, Ohio

Pension Specialist 2001-2002

Creating and maintaining pension records on retiring associates.

Calculating length of service and creating deferred pension records on terminated associates.

Creating 401(k) records for newly hired associates, maintaining the increases and decreases of contributions to the 401(k) plan.

Process loans, hardships and withdrawal information from the 401(k) plan.

CIGNA Healthcare, Cincinnati, Ohio 1990-2001

Lead System Administration Specialist (2001)

Contract Administrator (1997-2001)

Adjustment Analyst (1996-1997)

Benefit Analyst (1992-1996)

Claims Examiner (1990-1992)

Affiliations:

National Council of Negro Women, Inc.

Former Cincinnati Chapter President of the National Association of Professional Women

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