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Skills

  • High-volume claim processing
  • Business operations
  • RFI Scanners
  • Team building
  • Financial reconciliation
  • Organizational skills
  • Problem resolution
  • Insurance billing
  • Escalation management
  • MS Office

Work Experiences

  • Worked with others to brainstorm new metric possibilities.
  • Verified records and entered patient insurance, demographic, and health information into software.
  • Advised patients on in-network vs. out-of-network benefits.
  • Developed a reputation for punctuality and hard work.
  • Achieved a 41% faster payment cycle.
  • Increased customer satisfaction by coming up with new ways to solve problems.
  • Collaborated with sales for software integration.
  • Achieved recovery in the past year.
  • Increased profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
  • Used Asana to compile data gathered from various sources.

Summaries

  • Medical Insurance Coordinator is a hardworking and dependable Medical Insurance Coordinator who excels at team leadership and performance reporting.
  • Strategic thinker with expertise in strategic planning.
  • With hands-on experience, eager to learn new skills and advance knowledge.
  • Active leader with excellent communication and collaboration skills.
  • Program, system, and standard are all available.
  • Adept in financial counseling.
  • Acted as a liaison between departments and payers.
  • Achieved a 35% reduction in claim denials.
  • Achieved 28% recovery of underpaid claims.
  • Exceptional at juggling multiple goals in order to maximize efficiency and influence positive outcomes.

Accomplishments

  • Analyzed claim denial patterns using Adobe Creative Suite, successfully appealing and overturning 31% of rejections on average.
  • Served as a liaison between patients and insurance payers, resolving disputes and correcting billing discrepancies that improved patient satisfaction by 85%.
  • Streamlined the insurance claim submission process, reducing denial rates by 21% through consistent claims follow-up and payer outreach.
  • Collaborated with providers and payers to negotiate favorable reimbursement rates for out-of-network services, driving a 66% increase in average reimbursement per claim.
  • Optimized the claims workflow in 2024, leading to a 80% faster processing time for both commercial and governmental programs.
  • Advised patients on eligibility and in-network provider options, resulting in a 40% reduction in non-covered claims.
  • Exceeded departmental collection goals by 23% through effective claims overseeing and denial resolution in category platform.
  • Identified key trends in rejected claims and implemented corrective measures, reducing overall denial rates by 75% over the past year.
  • Implemented same-day verification protocols in collaboration with framework, reducing insurance verification cycle time by 3 hours.
  • Recovered over $9 in denied claims through the diligent investigation of payer policies and resubmission of corrected claims.

Affiliations

  • Attended the annual summit of the Association of Insurance Compliance Professionals (AICP), focusing on regulatory challenges in healthcare insurance.
  • Volunteered for local healthcare advisory board panel discussions on improving the efficiency of medical billing and compliance.
  • Joined local Phoenix chapter of the Government Employee Benefits Coordinators to stay informed on federal healthcare policies and member benefits programs.
  • Joined the Medical Insurance Coordinator Professional Network on procedure, frequently contributing best practices for reducing claim denial rates.
  • Leveraged membership in the Medical Society Business Administrators (MSBA) to refine background knowledge in business operations and insurance claim processing.
  • Participated in coding and billing workshops hosted by the Professional Association of Health Care Office Management (PAHCOM).
  • Enrolled in workshops provided by the American Academy of Medical Administrators (AAMA) to refine skills in medical insurance coordination.
  • Completed continuing education through AHIP (America’s Health Insurance Plans) focused on evolving compliance regulations.
  • Attended 2023 national conference of the Medical Group Management Association (MGMA) to explore solutions in healthcare administration and insurance challenges.
  • Member of the International Claim Association (ICA) to enhance understanding of insurance claim adjudication and dispute resolution.

Certifications

  • Certified Claims Specialist (CCS) - Ironclad Systems
  • Google Certified Professional Cloud Architect
  • Cisco Certified Network Associate (CCNA)
  • Certified Healthcare Financial Professional (CHFP) - method
  • ServSafe
  • SHRM Certified Professional (SHRM-CP)
  • Certified Medical Insurance Specialist (CMIS) – American Medical Billing Association
  • Certified Business Analysis Professional (CBAP)
  • Certified Medical Office Manager (CMOM) - Practice Management Institute
  • Healthcare Revenue Cycle Analyst Certificate - Vantage

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