RHONDA BERTRAND

***** ****** ******** · Farmington, AR. 479-***-****

ade22s@r.postjobfree.com

Exceptionally organized and detail-oriented individual coming with skill set covering project and process management, planning, communication, and interpersonal skills developed from hands- on progressive experience in the insurance and healthcare industry. EXPERIENCE

NOVEMBER 2011 – PRESENT

CLAIMS PROCESSING MANAGER, TYSON FOODS

• Direct, supervise and evaluate work activities of a team of bill review analysts and specialty review nurses.

• Establish work schedules and assignments for staff, according to workload, space and equipment availability.

• Maintain awareness of advances in medicine, computerized diagnostic and treatment equipment, data processing technology, government regulations, health insurance changes, and financing options.

• Prepare activity reports to inform management of the status and implementation plans of programs, services, and quality initiatives.

• Manage change in integrated health care delivery systems, such as work restructuring, technological innovations, and shifts in the focus of medical coding methodologies.

• Consult with medical providers, key business stakeholders, and community groups to discuss Service problems respond to community needs, enhance public relations, coordinate activities and plans, and promote health programs.

• Develop instructional materials and conduct in-service and community-based educational programs.

MAY 2007 – DECEMBER 2014

RISK MANAGER, TYSON FOODS

• Review excess policy to determine amount of insurance in force on single risk or group of closely related risks.

• Examine documents to determine degree of risk from such factors as claimant’s life expectancy and degree of injury and contributing factors.

• Evaluate possibility of losses due to catastrophe or excessive insurance.

• Write to claim adjusters, claim supervisors, and others to obtain further information, total exposure, or explain excess special handling policies. APRIL 2004 – MAY 2007

WORKERS COMPENSATION ADJUSTER, TYSON FOODS

• Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.

• Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.

2

• Resolve complex, severe exposure claims, using high service-oriented file handling.

• Pay and process claims within designated authority level.

• Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

• Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.

• Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.

• Confer with legal counsel on claims requiring litigation.

• Contact or interview claims, doctors, medical specialists, or employers to get additional information.

• Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.

• Present cases and participate in their discussion at claim committee meetings

• Conduct detailed bill reviews to implement sound litigation management and expense control.

• Report overpayments, underpayments and other irregularities.

• Communicate with reinsurance brokers to obtain information necessary for processing claims.

• Prepare reports to be submitted to company’s data processing department. SEPTEMBER 1999 – APRIL 2004

BILL REVIEW ANALYST, TYSON FOODS

• Responsible for performing technical review of complex medical bills

• Generated assigned medical bills to determine compliance with business rules, client specific requirements and state specific fee schedules, rules regulations and guidelines.

• Responsible for making bill review processing determination according to rules and regulations

• Evaluated medical bills and corresponding EORs

• Processed reconsiderations as necessary.

• Assigned specialty pricing fees to appropriate client claims

• Reviewed, analyzed, adjusted and released queued bills in an accurate and timely manner.

• Responded to written or verbal provider inquiries relating to our bill review analysis

• Referred to reference library of fee schedules, CPT, ICD9 (10) to ensure correct billing of claim. MAY 1996 – AUGUST 1998

MEDICAL ASSISTING INSTRUCTOR, REMINGTON COLLEGE

• Supervise and monitor students' use of tools and equipment.

• Determine training needs of students or workers.

• Administer oral, written, or performance tests to measure progress and to evaluate training effectiveness.

• Observe and evaluate students' work to determine progress, provide feedback, and make suggestions for improvement.

• Prepare reports and maintain records such as student grades, attendance rolls, and training activity details.

• Conduct on-the-job training classes or training sessions to teach and demonstrate principles, techniques, procedures, or methods of designated subjects.

• Develop curricula and plan course content and methods of instruction.

• Develop teaching aids such as instructional software, multimedia visual aids, or study materials.

• Present lectures and conduct discussions to increase students' knowledge and competence using visual aids, such as graphs, charts, videotapes, and slides. 3

JULY 1992 – SEPTEMBER 1999

QUALITY TRANSCRIPTION, OWNER

• Transcribe dictation for a variety of medical reports, such as patient histories, physical examinations, emergency room visits, operations, chart reviews, consultation, or discharge summaries.

• Review and edit transcribed reports or dictated material for spelling, grammar, clarity, consistency, and proper medical terminology.

• Distinguish between homonyms and recognize inconsistencies and mistakes in medical terms, referring to dictionaries, drug references, and other sources on anatomy, physiology, and medicine.

• Return dictated reports in printed or electronic form for physician's review, signature, and corrections and for inclusion in patients' medical records.

• Translate medical jargon and abbreviations into their expanded forms to ensure the accuracy of patient and health care facility records.

• Take dictation using either shorthand or a stenotype machine or using headsets and transcribing machines; then convert dictated materials or rough notes to written form.

• Identify mistakes in reports and check with doctors to obtain the correct information. EDUCATION

AUGUST 2014

BACHELOR OF ARTS-HEALTH CARE MANAGEMENT, GRACELAND UNIVERSITY GPA 3.46 Magna Cum Laude

APRIL 2015

CERTIFIED PROFESSIONAL CODER (CPC), AMERICAN ACADEMY OF PROFESSIONAL CODERS

(AAPC)

GPA 4.00

APRIL 2004

LICENSED WORKERS COMPENSATION ADJUSTER, ARKANSAS

Current

APRIL 1997

REGISTERED MEDICAL ASSISTANT, ARKANSAS

Inactive

ACTIVITIES

AAPC- Served in several different leadership positions for the local chapter including President, Vice President, Education Officer and Secretary.

Network of Executive Women- 2017 to present

Girl Scouts of America- 10 years of service

4

REFERENCES

Jane Duke

VP & Assoc General Counsel

Law Department, Tyson Foods

ade22s@r.postjobfree.com

Melisa Yopp

Managing Director of Workers Compensation

Law Department, Tyson Foods

ade22s@r.postjobfree.com

Mary Fletcher

Associate Director of Case Management+

Law Workers Compensation, Tyson Foods

ade22s@r.postjobfree.com

Sherri Hansen

Sr Manager Claims

Law Workers Compensation, Tyson Foods

ade22s@r.postjobfree.com

Randall Schmidt

Sr. Client Services Manager/Casualty Solutions Group, Mitchell International, Inc ade22s@r.postjobfree.com

Additional references available on request

Contact this candidate