Revenue Cycle Business Development
Resume:
Tayla Reddic
Arlington, TX *****
***********@*****.***
Professional Summary
Experienced Medical Insurance Specialist with a strong background in Revenue Cycle Management, including billing, coding, claims processing, and dispute resolution. Proven ability to lead cross-functional teams and implement data-driven process improvements. Key strengths include: Expertise in Epic, Excel, 3M/360, Meditech, Kareo, and Allscripts Strong understanding of ICD-10-CM/PCS, MS-DRG, risk adjustment models, and HCC coding Skilled in managing inpatient, outpatient, and ancillary claims across multiple specialties Track record of fulfilling federal/state compliance requirements and HIPAA regulations Experienced in project management, business development, finance, operations, and administration Collaborative, resourceful, and adaptable team player with excellent problem-solving abilities Committed to quality standards, staff development, and boosting team performance Sorting and filtering data
Using PivotTables to summarize data
Applying formulas l.
Creating charts and graphs
Using the Data Analysis Toolpak for things like regression, histograms, and descriptive statistics Conditional formatting to highlight key data
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
QPA Specialist / Appeal Specialist
Brighton Health Plan Solutions-Remote
May 2023 to January 2025
Conducts advanced claims processing for professional, facility, and ancillary claims, with a focus on reviewing claims and provider contracts to prepare for QPA (Qualified Payment Amount) negotiations. Responds accurately and promptly to provider disputes, ensuring clear communication across teams to expedite resolutions. Applies medical policies and contractual guidelines for accurate adjudication, documents research findings, and supports customer service with issue resolution. Contributes to problem-solving, process improvement, and maintains a strong understanding of client products and services.
RCM Specialist
Advantum Health-Remote
April 2022 to May 2023
Oversees regional revenue cycle management (RCM) by implementing and monitoring KPI-driven educational programs for operations staff, and tracking performance progress. Collaborates with RCM senior analysts, lead billers, and operations teams to develop strategic plans for achieving revenue goals. Leads team activities, assigns responsibilities, and maintains regular communication to align with company objectives. Partners with practice managers to execute and monitor action plans or process changes. Ensures compliance with healthcare billing regulations and stays current with industry standards. Supports multiple specialties, including inpatient surgery, acute care, pathology, cardiology, anesthesiology, and radiology, and contributes to special projects as needed. Inpatient Senior Coding Specialist *Contract*
Arc Healthcare-Remote
June 2022 to October 2022
Possesses strong expertise in Epic, 3M/360, Meditech, and Allscripts. Successfully processed independent dispute resolution (IDR) reviews in compliance with state and federal reporting protocols. Ensured treatment effectiveness by analyzing inpatient and outpatient billing processes and supported payment integrity through detailed charge reviews. Applied inpatient coding standards and clinical assessments while serving as an arbiter in case evaluations. Contributed to quality improvement initiatives and supported routine operations, including agency-wide projects as a subject matter expert. Oversaw team performance through evaluations and incentives, with specialization in inpatient acute care, labs, and surgery.
Inpatient Risk Adjustment Coder *Contract*
Cavo-Remote
January 2022 to May 2022
Demonstrates strong proficiency in Epic, 3M/360, and Kareo, with extensive experience in inpatient medical coding within acute care settings. Analyzed patient records to assign accurate ICD-10-CM codes for risk adjustment models and ensured documentation accuracy by addressing flagged events. Maintained quality assurance standards based on HCC scoring models while meeting coding productivity benchmarks. Applied standardized coding guidelines consistently and upheld HIPAA compliance in all healthcare services. Possesses a solid understanding of risk adjustment coding and data validation for accurate diagnosis coding.
Coding Supervisor/Trainer
Ameriben IEC Group-Remote
June 2017 to December 2021
Highly proficient in Epic and 3M/360, with deep expertise in ICD-10-CM/PCS coding and MS-DRG classification to enhance inpatient coding accuracy and coder productivity. Delivered advanced, compliant computer-assisted coding solutions using 3M 360 Encoder. Improved patient access by efficiently scheduling diagnostic and ancillary services, prioritizing appointments, and selecting appropriate providers and referral types. Minimized patient record duplication and overlays using the GBAS method for MRN management. Conducted thorough patient registrations and interviews to ensure complete and accurate data collection.
Skills
• Revenue cycle management (8 years)
• Epic (8 years)
• Staff training (8 years)
Links
https://www.linkedin.com/in/tayla-reddic-44654a175? utm_source=share&utm_campaign=share_via&utm_content=profile&utm_medium=ios_app
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