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Skills

  • Relationship development
  • Administrative support
  • Rules of evidence
  • Planning and coordination
  • Customer service excellence
  • Property adjusting
  • HAZMAT expert
  • Client Communication and Support
  • Process improvement
  • Invoice generation

Work Experiences

  • Worked closely with law enforcement and testified in criminal cases.
  • Assisted in acquiring and managing additional resources during peak claim appeal periods, improving outcomes by 57%.
  • Authored internal guidelines for appeal documentation.
  • Salesforce was delivered to customer locations by me.
  • Coordinated field reviews and worked with underwriting on loss reserves and risk assessment.
  • Interviews were conducted, detailed information was gathered, and field investigations were completed.
  • Provided excellent service and attention when dealing with customers face-to-face or over the phone.
  • Achieved a 60% increase in daily resolution rates.
  • Achieved resolutions within 18 months.
  • Worked with others to brainstorm new procedure possibilities.

Summaries

  • Team leadership in initiative settings and team leadership in stakeholder engagement settings.
  • Achieved quicker resolutions.
  • Knowledge of Salesforce in depth, as well as performance reporting and risk assessment abilities.
  • Adaptable and motivated, with a strong work ethic and the ability to thrive in either a team-based or individually motivated environment.
  • Strong technical skills and experience in process improvement.
  • Motivating leader who has built and managed system teams in the past.
  • Lean certified
  • Ability to recognize system issues and integrate program solutions to achieve system.
  • Communicative and team-oriented, with SAP expertise.
  • Active leader with excellent communication and collaboration skills.

Accomplishments

  • Championed new CRM software integration that improved tracking and case follow-up, reducing unresolved appeals by 68%.
  • Developed a risk mitigation strategy to handle denied claims, resulting in a 61% reduction in appeals resulting in litigation.
  • Streamlined communication between claims department and finance teams, reducing outstanding appeals by 53% over a the past year.
  • Achieved a 54% success rate in recovering payments for previously denied claims by utilizing data-driven negotiation techniques.
  • Analyzed and implemented change requests to existing processes, increasing team accuracy rate by 80% and reducing claim turnaround time.
  • Instrumental in reducing denied medical claim disputes by 15% through close collaboration with billing departments.
  • Processed an average of 17 claim appeals per day, achieving a resolution success rate of 57% in favor of clients over a three years.
  • Trained junior team members on claims handling and appeal strategies, resulting in a 79% improvement in team efficiency.
  • Conducted thorough investigations of denied claims, overturning decisions on 18% of appealed cases, saving clients over $145,000.
  • Reduced overall appeal processing time by 32% through the implementation of automated workflows within the Jira system.

Affiliations

  • Member, Medical Group Management Association (MGMA)
  • Editor of Claims Resolution Newsletter, Harbor & Co., 2022
  • Volunteer, Health Information Management Services Department, Phoenix
  • Certified Medical Office Manager (CMOM), Practice Management Institute
  • Certified Compliance Professional (CCP), 2024
  • Participant, Advanced Claims Appeals Training Program at Ironclad Systems
  • Member, National Healthcare Collectors Association
  • Certified Professional Coder (CPC), AAPC, 2021
  • Chair, Claims Appeals Task Force, 2024
  • Affiliate Member, American Medical Association (AMA) 2017

Certifications

  • ServSafe
  • Medical Billing & Coding Specialist (MBCS), Northwind
  • Certified Professional Coder (CPC) - AAPC
  • Medical Claims and Billing Specialist Certification - Brightline
  • Certified Health Insurance Specialist (CHS), AHIP
  • SAP Certified Application Associate
  • American Academy of Financial Management (AAFM)
  • Certified Patient Account Representative (CPAR) – AAHAM
  • Certified Medical Reimbursement Specialist (CMRS) - AMBA
  • Certified Healthcare Compliance (CHC) - HCCA

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