Rebecca Everett Email & Phone Number

Kansas City, MO, US

• Streamlined Claims Processing: Reviewed live claims for medical necessity, pre-existing conditions, infertility services, and prior authorizations, exceeding monthly goals by 100%. This ensured accurate and efficient.
• Enhanced Care Coordination: Collaborated with physicians, case managers, and other healthcare professionals to resolve claim issues, prioritize inquiries, and reduce customer/provider frustration. Served as a liaison.
• Boosted Efficiency and Compliance: Identified workflow inefficiencies, proposed SOP improvements, and organized workload for optimal department performance. Supported accreditation efforts by ensuring adherence to.
• Championed Process Improvement: Participated in performance improvement initiatives to streamline workflows across the organization, leading to increased productivity within departments.

• Boosted Team Performance: Increased team productivity through efficient workflow implementation and clear expectations. Developed staff skills with targeted training, leading to improved performance and career.
• Enhanced Operational Efficiency: Streamlined operations for increased efficiency. Identified and addressed operational inefficiencies, leading to an overall 95% improvement in effectiveness. Championed continuous.
• Cultivated Positive and Productive Work Environment: Reduced employee turnover by fostering a positive work environment and providing ongoing feedback. Resolved conflicts promptly, maintaining a harmonious and.
• Improved Customer Satisfaction: Improved customer satisfaction with timely responses, addressing concerns effectively, and finding solutions. Cultivated strong relationships with key clients through consistent.
• Leadership and Collaboration: Led major departmental initiatives that drove innovation or addressed critical business challenges. Collaborated effectively with other departments to achieve organizational goals..

• Streamlined Claims Processing: Reviewed live claims for medical necessity, pre-existing conditions, infertility services, and prior authorizations, exceeding monthly goals by 100%. This ensured accurate and efficient.
• Enhanced Care Coordination: Collaborated with physicians, case managers, and other healthcare professionals to resolve claim issues, prioritize inquiries, and reduce customer/provider frustration. Served as a liaison.
• Boosted Efficiency and Compliance: Identified workflow inefficiencies, proposed SOP improvements, and organized workload for optimal department performance. Supported accreditation efforts by ensuring adherence to.
• Championed Process Improvement: Participated in performance improvement initiatives to streamline workflows across the organization, leading to increased productivity within departments.

• High-Volume Reviewer: Efficiently managed daily caseload of 13-25, ensuring timely and accurate reviews.
• NICU Program Champion: Played key role in launching NICU program by requesting policy inclusion for newborns, reviewing admissions, tracking claims, and collaborating with membership and claims departments for seamless.
• Benefits and Coverage Expertise: Demonstrated strong clinical knowledge by evaluating medical guidelines and benefit coverage to determine service appropriateness.
• Problem-solving Skills: Devised or identified solutions for irregular requests and issues, ensuring accurate claim processing.
• Cross-Trained and Flexible: Proactively filled in for colleagues by leveraging cross-training in medical claims review, demonstrating adaptability and a commitment to team support.
• Prior Authorization Proficiency: Conducted reviews for services requiring prior authorization, ensuring proper member coverage and efficient service delivery.

Kansas City, Missouri Area

• Secured Authorizations: Efficiently secured authorizations from multiple insurance carriers for various care levels, ensuring seamless patient transitions.
• High-Volume Review with Clinical Expertise: Reviewed a high volume of patient charts, leveraging strong nursing knowledge and state guidelines to determine medical necessity.
• Coding Proficiency: Collaborated with insurance agents regarding ICD-10 and CPT codes, demonstrating expertise in medical coding.
• Complex Case Collaboration: Partnered with Medical Director to review clinically complex patients, ensuring appropriate care delivery.
• Cost-Containment Champion: Employed comprehensive utilization review strategies (prospective, concurrent, retrospective) to optimize resource allocation.
• NICU Revenue Code Expert: Served as subject matter expert in NICU revenue codes, ensuring accurate billing and reimbursement.

Kansas City, Missouri Area

• 40 bed Level IIIb NICU unit.
• Advanced Care for Critically Ill Newborns: Delivered comprehensive, developmentally appropriate care to critically ill infants in a high-acuity Level IIIb NICU, utilizing advanced interventions like HFOV, INO, PICC.
• Family-Centered Champion: Provided compassionate support and education to families, fostering trust and collaboration through open communication.
• Collaborative Care Coordination: Ensured seamless communication with physicians, implementing orders, interpreting test results, and jointly planning care with families and the medical team.
• Leadership and Mentorship: Led key initiatives including:Infection Control Champion: Reduced CLABSI rates through evidence-based practice implementation and educational programs.Mentor Program Co-creator and Co-chair.

• Patient-Centered Caregiver: Delivered comprehensive daily care to patients, including bathing, ambulation, feeding assistance, toileting, IV removal, and blood glucose monitoring, ensuring their comfort and well-being.
• Relationship Builder: Fostered trusting and caring relationships with patients and families, creating a supportive and compassionate healing environment.
• Clinical Vigilance: Proactively identified patients with declining health conditions and promptly notified the STAT Team, ensuring timely intervention and potentially life-saving measures.

Kansas City, MO

• Client Advocate: Resolved a wide range of customer inquiries for credit card and student loan clients, including billing disputes, credit line increases, and account management.
• Collections Specialist: Handled both inbound and outbound collections calls, recovering delinquent student loan debt while maintaining professionalism and de-escalating frustrated customers.
• Coaching and Development: Mentored new hires and existing associates, ensuring efficient onboarding and successful performance.
• Results-Oriented: Consistently achieved goals, earning recognition through multiple Citi Star Awards, 3x Citi Quality Excellence Awards, and Student Loans Employee of the Month.

Bachelor Of Science (Bs), Registered Nursing/Registered Nurse, 4.0

Activities and Societies: SLSNA: Community Committee, Saint Luke's Honor Society• Graduated Summa Cum Laude • President's List all 4.

Pre-Nursing Studies, 3.96

Activities and Societies: Phi Theta Kappa