Rebeca Thomas Email & Phone Number

Charlestown, Ma

Supervised COB Team: Led all COB staff activities to ensure efficient operations and optimal performance.Quality Control: Monitored and evaluated the accuracy and timeliness of initial claims, appeals, and COB Medicare files for NH and MA; Claims Management: Reduced a backlog of 9,000 claims within 5 months of starting the role, improving resource management to achieve a two-week lead time and preventing compensatory damages for non-compliance with the 30-day turnaround on clean claims.Project Management: Oversaw claims automation projects with Cognizant, driving efficiency and innovation in claims processing.Compliance & Reporting: Managed SCO, ACO/MCO, NH Medicaid, and annual CMS Part C reporting, ensuring adherence to departmental standards and timely corrective actions.Regulatory Knowledge: Maintained knowledge of COB payment methodologies, Medicare/Medicaid eligibility rules, and Third Party Liability claims, aligning processes with industry standards.Policy Documentation: Updated OPL policies and training manuals to ensure accuracy and compliance.Staff Development: Participated in hiring, training, and performance management to promote team growth and efficiency. Collaborated with HR to develop action plans based on quality metrics.Cross-Department Collaboration: Coordinated with supervisors to resolve operational challenges and develop cross-functional initiatives.Team Leadership: Facilitated meetings and professional development to foster a productive work environment.Technical Proficiency: Utilized Microsoft Office (Word, Excel, Outlook), OnBase, Crystal Reports, and Facets for operational efficiency.Analytical Skills: Applied investigative and analytical skills for effective problem-solving.Managed Care Experience: Worked in Managed Care Organizations for MassHealth and New Hampshire Medicaid, including Dual Enrolled (Medicare and Medicaid Plans), enhancing regulatory and integrated care knowledge.

Boston, Massachusetts, United States

Provide Administrative and Compliance tracking of tasks and project deadlines for the OPL, TPL, Credit Balance and Audit Departments. Creating excel templates, Macros to automate duplicate tasks with embedded customized dynamic calculations.Creating, loading and running reports Congos reports and customizing them within Excel for departmental use.Working with share point to make collaborative spreadsheets within the team.Streamlining processes to have the department run more efficiently.Create templates with embedded customized calculations to display data within dashboards to monitor, manage and project production and quality scoring for a team of 16 members. Provide data driven business outcomes reports and visualizations.Create departmental training curriculum, training slides, handouts, reference guides and manuals. Conduct and facilitate training sessions.Assign medical claims to internal auditors per CAD system.Gained hands on experience with FACETS and claim processing within the coordination of benefits policies and procedures.

Boston, Ma

Assisting the Director and Customer Service Manager in special projects coordination. Provided Data analysis of the customer service call log through self created formulated google spreadsheets and excel. Designed and created Google Forms (online forms) for various transportation requests and converted the source data into groups for each of the Transportation Officers. Designed and created a training manual for the customer service representatives for 5 computer software. Answered and provided customer service to clients to of the Department of Transportation. Assisted in the development of a comprehensive Anti-Bullying campaign proposal. Provided customer resolution through collaboration with different staff members within the department and within other departments to facilitate a conclusion that still fits within the parameters of the policy. Managed 8 temporary workers to complete a project earlier than anticipated while saving department money in the process. Establishing workflows through strategic planning and effective implementation.

Create and coordinate outreach and recruitment of families for the programexecuting the federal regulations in collecting documentation and completing applications with families.Generate reports from Promis to ensure our program are within guidelines outlined in the Federal regulations; attendance, enrollment, income of families and Data Quality Assurance.Fostered Community Relationships that will meet the needs of the families of our program.Processed payroll for the site. Generated an accounting system to receive co-parent fees from parents. Reconciled payments weekly. Monitored enrollment for 100 seats in the program and maintained 95% enrollment. Increased income for the program by 50% because of my relentless recruiting efforts.

Ensure that the program maintained state and federal regulations to ensure licensing.Coordinated program events that encouraged family engagement.Assisted the program director with program correspondences to parents and staff.Organized staff files and updated the EEC staff checklist per the state regulations.Created an invoicing system to collect the parent co-parent fees.

South Boston, Ma

• Setup QuickBooks software to begin a computerized A/P and A/R. • Scheduled and managed payroll for employees. • Reconciled monthly bank statements for accounts; EFT transactions, cash and checks • Assisted in year end closing and post closing transactions. • Worked and managed the owner’s business dealings and schedule

• Process transactions accurately and efficiently in accordance with policies and procedures. • Responsible for pulling daily, weekly and monthly reports; balancing accuracy, Daily Sales, weekly performance for the tellers and for the bank center. • Analyzed reports to target areas to met business needs.• Managed a computerized database for outbound calling and updated information by editing and making corrections as needed.

Associate Of Arts - Aa, Accounting

Business Concentration, Data Modeling/Warehousing And Database Administration