Seasoned Rating Veteran Service Representative bringing over 20-year demonstrated track record of success in Department of Veterans Affairs as a clinic nurse, Veteran Service Representative, and Rating Veteran Service Representative. Successful at performing potent and highly effective analysis for Veteran's claim process regarding service connection, evaluation of disabilities, medical and dental treatment, permanent and total disability, special monthly compensation, Chapter 35 Dependents Educations Benefits and ancillary benefits with an efficiency-driven and accurate approach. Prepared to offer skills and experience to facilitate and further the goal of exceptional service to Veterans. Seeking to apply extensive rating application knowledge to assist in the quality assurance program. Proficient in M21-1 Adjudication Procedure Manual and 38 CFR/Code of Federal Regulation.
Skills
Knowledge and skill in applying analytical and evaluative methods and techniques in order to competently adjudicate claims.
Applied and utilized education and nursing degrees in leading exam training and "ready for decision" training to Veteran Service Representatives.
Skilled end user and knowledge of personal computers and various software applications including VBMS, VBMS-R, CAPRI, JLV, M21-1 Adjudication Procedure manual, 38 CFR/Code of Federal Regulations, EPSS, SHARE, Index of Court Cases and Decision Assessment Documents, Microsoft TEAMS, TMS, STAR reports and DBQ Dashboard.
Extensive knowledge of anatomy and physiology, diseases and disabilities with the ability to assess sources of evidence and information to arrive at rating decisions.
Ability to read, understand, interpret and apply pertinent laws, regulations and procedures. This includes the ability to read, understand and interpret medical and legal terminology.
Ability to communicate orally with people, including Veterans, management and co-workers, from a variety of backgrounds and with varying levels of understanding.
Ability to work under stressful conditions. This includes the ability to work under time pressure and the ability to maintain self-control.
Diligent quality reviewer and mentor for Veteran Service Representatives and new/trainee Rating Veteran Service Representatives with proficiency in VBA regulations and procedures.
Tracked and analyzed quality exceptions/data for new Rating Veterans Service Representatives on trainee tracker.
Explained rationale and provided appropriate citations to trainee Rating Veterans Service Representatives.
Conduct analysis of STAR error reports/reviews to identify trends in quality, significant problem areas and processes requiring improvement for individual and trainee performance.
Strong aptitude for working with little supervision in remote environments.
Highly empathetic and supportive team player with upbeat, positive attitude and proven skills in establishing rapport with co-workers and management.
Specialized in quality, speed and process optimization.
Knowledgeable about Veterans benefits/compensation and skilled at meeting and exceeding central office targets/goals.
Service-oriented and quality-focused with demonstrated success over 20 years of Department of Veterans Affairs experience in health care and benefits.
Reasoning - Identifies rules, principles, or relationships that explain facts, data, or other information; analyzes information and makes correct inferences or draws accurate conclusions.
Self-Management specialist with well-defined and realistic personal goals; high level of initiative, effort, and commitment towards completing assignments in a timely manner with minimal supervision.
Prepared and conducted formal training sessions: including but not limited to training for newly hired personnel, refresher training and other necessary training approved by coaches/management due to changes in procedures, regulations, or law.
Provide assessments to first-line Supervisor/Coach detailing strengths and weaknesses observed in trainees with way to successfully improve their performance.
Independently prepare for and conduct formal hearings.
Experience
Rating Veteran Service Representative, 06/2006 to Current Healthcare Partners – Pavilion, WA,
Expert adjudicator with over 20 years of claims processing experience utilizing exceptional service, employee and Veteran focused techniques to enhance efficiency and performance.
Evaluated all evidence and reconciled discrepancies to provide accurate entitlement determinations in accordance with applicable laws, guidelines, and regulations.
Consistent in exceeding productivity and quality goals with yearly awards for exceptional criteria including special cash awards.
Analyzed claims to make determinations regarding service connection, evaluation of disabilities, medical and dental treatment, permanent and total disability, special monthly compensation, and ancillary benefits.
Served in several special project groups/special operations to include military sexual trauma coordinator, Nehmer Team, traumatic brain injury, amyotrophic lateral sclerosis, and Blue Water Navy claims.
Provided special mentor review and second signature for new RVSR trainees.
Provided upper level management with brainstorming and development of a special "Ready for Decision" review team during COVID-19 low inventory of ready for decision cases.
Collaborated with Pre-Team quality reviewer and developed a "Ready for Decision Tips and Tricks" short training review for Veteran Service Representatives during period of low volume of ready for decision cases in the service center.
Identified skill gaps through one-on-one mentoring to help at risk employees successfully complete Performance Improvement Plans and reach single signature.
Collaborated with supervisory personnel to complete upper management special tasker case reviews and high level priority problem cases to improve regional office performance.
Maintained flexibility to changing priorities and workloads, processing various type of claims for over 20 years.
Volunteered for special projects/tasks to include Blue Water Navy, Nehmer Review project, Exam training for Veteran Service Representatives, timekeeper, Military Sexual Trauma Coordinator, Spec Ops Team, RVSR skills certification test mentor, mentor for new/trainee Rating Veteran Service Representatives.
Provided written and verbal guidance with quality review to coaches as a mentor on complex and special front office tasker cases.
Conducted formal hearings with Veterans and their representatives to resolve questions and challenges on proposals to reduce benefits.
Veteran Service Representative, 06/2002 to 06/2006 Veteran Benefits Administration – City, STATE,
Served as Senior Veteran Service Representative trainer/mentor for new Veteran Service Representatives.
Reviewed claim folders for completeness and conformity to guidelines prior to submission.
Assisted veterans in preparing forms, documents and applications for benefits.
Served as a primary contact for veterans, their beneficiaries, and their representatives and as the decision-maker for compensation or pension claims.
Interviewed veterans and dependents to determine eligibility for federal and state benefits while serving on the public contact team.
Made determinations as to eligibility for the type of benefit sought and analyzed, developed, and requested required evidence for certain claims requiring a rating decision.
Decided the necessity for and type of examination, reexamination or opinions to determine the existence of or to evaluate disabilities resulting from diseases or injuries.
Reviewed all correspondence to private attorneys; acknowledges and revokes designations for private attorneys.
Utilized various electronic data processing (EDP) systems for inputting data related to claims adjudication, processing, monitoring, and correspondence preparation.
Applied a wide variety of reference materials to include manuals, directives, letters and other guidance in the decision-making process.
Applied knowledge of anatomy and physiology, diseases and disability to assess sources of evidence and information necessary to determine percentages of disabilities, permanent and total disability, and entitlement to compensation, pension and vocational training.
Worked within a team environment and served as a legal technician gathering requisite evidence from medical, military, community, and other sources to support benefit determinations.
Prepared letters and other written material for internal and external customers.
Contacted veterans, Powers of Attorney, and dependents of veterans in order to obtain information needed to process a veteran's claim.
Analyzed medical evidence, benefit and/or legal evidence to identify and recognize required actions for claim development.
Analyzed, developed and requested required evidence for claims not requiring a rating decision, such as accrued benefits, apportionment decisions, incompetency issues, etc., to develop and/or adjudicate claims or appeals.
Successfully served on a training team and mentored new employees on laws, regulations and organization policies.
Clinic Nurse, 07/1997 to 05/2002 Veterans Health Administration – City, STATE,
Hours worked per week: 40 Series: 0620 Pay plan: GS Grade: 5
Triaged patients' issues based on stated symptoms, basic assessments and documented vitals.
Cared for clinic patients by administering medications and treatments for various conditions.
Used CPRS/CAPRI to update electronic medical records with relevant patient information such as in-house laboratory test results and clinician orders.
Performed nursing assessments and collected patient medical histories to help determine proper diagnosis.
Prepared patient rooms for visits by including cleaning, sanitizing equipment and stocking supplies.
Instructed patients and family members on medication and treatment instructions to promote adherence to guidelines.
Developed and maintained quality care systems and standards, including creating and improving medical protocols and guidelines.
Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services.
Immunized patients against influenza and pneumonia to protect vulnerable populations from serious illnesses.
Documented all therapies, including immunizations and diabetic checks to keep patient charts up-to-date.
Counseled patients and caregivers, providing emotional, psychological and spiritual support.
Cared for patients recovering from amputations and other surgical procedures and provided personalized daily assistance.
Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
Observed strict safety measures, including checking medication dosages before administration to patients.
Administered oral, IV and intra-muscular medications and monitored patient reactions.
Communicated with primary care physicians or emergency care providers to relay patient needs.
Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
Stocked clinical workstations and procedure rooms with necessary supplies.
Conducted patient assessments and diagnostic tests to provide physician with important patient health information.
Participated in continuing education programs and clinic/hospital workshops to enhance training and nursing knowledge.
Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
Answered patient questions and provided take-home materials for further information.
Reached out to patients to convey lab results and provide care instructions.
Education and Training
: Rating Veteran Service Representative, Expected in 07/2006 Department Of Veterans Affairs Challenge - Louisville, KY, GPA:
Associate of Science: Nursing, Expected in 05/2000 Southeastern Illinois College - Harrisburg, IL GPA:
Bachelor of Arts: Education, Expected in 05/1991 Southern Illinois University Carbondale - Carbondale, IL GPA:
Accomplishments
Consistently maintained high customer satisfaction ratings with no customer service deficiencies in over 20 years.
Earned annual individual cash awards for exceeding national/local Rating Veteran Service Representative Standards at the exceptional level consecutively since 2012.
Volunteered for the first Rating Veteran Service Representative Skills Certification test receiving a passing score and bonus cash award.
Passed all consecutive skills certification tests for Journey level Rating Veteran Service Representative with the most recent certificate dated July 9, 2018.
Earned two quality step increases in December 2014 and December 2019.
Completed Registered Nursing degree and passed the Illinois State Nursing Boards in May 2000 on first attempt while working full-time as a Licensed Practical Nurse for the Marion VA Medical Center.
Promoted from Veteran Service Representative to Senior Veteran Service Representative/Trainor in 2004
Promoted to Rating Veteran Service Representative in 2006 with less than 4 years at the service center.
Chosen as trainer/mentor to new Rating Veteran Service Representatives on numerous occasions.
Chosen to provide exam training to RVSRs/VSRs 2008-2009
Chosen to provide "Ready for Decision Tips and Tricks" training to Veteran Service Representatives during COVID-19.
Volunteered to serve as Traumatic Brain Injury rating specialist.
Volunteered to serve as Military Sexual Trauma Coordinator, exam trainor, and timekeeper under Coach Sandra Thomas.
Chosen as a member of the "Ready for Decision" team during COVID-19.
Missouri Registered Nursing License 2001008917 ACTIVE
Illinois Registered Nursing License 041319354 ACTIVE
Honors graduate from both Southeastern Illinois College and Southern Illinois University-Carbondale.
Member of Kappa Delta Pi, Alpha Kappa Alpha, Phi Kappa Phi, and Whose Who while enrolled at Southern Illinois University-Carbondale and Southeastern Illinois College.
Certifications
Licensed Registered Nurse Illinois 041319354 ACTIVE
Licensed Registered Nurse Missouri 2001008917 ACTIVE
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