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Skills

  • Conflict resolution
  • Regulatory compliance
  • Claims processing accuracy improvement
  • Account management
  • Business Planning
  • CMS compliance knowledge
  • Budgets
  • Billing and reimbursement systems knowledge
  • Operational improvement
  • Quotes and sales

Work Experiences

  • Customer satisfaction was impacted by policy changes and company conditions, which I reported.
  • Adapted to changes post-2020.
  • Achieved results over a 16-month period.
  • Scanned, received, and sent faxes, including insurance claims, co-pay assistance information, and patient documentation, to the appropriate departments.
  • Achieved a 40% success rate.
  • Achieved improvement over 2016.
  • Automated policy quote generation.
  • Assisted 9 clients annually.
  • Reduced error rates by 5% by detecting and correcting coding errors.
  • Achieved zero compliance issues.

Summaries

  • Achieved a 82% success rate in overturning claims denials.
  • Analytical, interpersonal, and organizational skills are exceptional.
  • Dedicated to learning, growing, and succeeding in Accounting and Finance.
  • Achieved $9 savings for business clients annually.
  • Costs were consistently reduced while profits were increased.
  • Accountable Insurance Representative with strong client management and plan promotion skills.
  • Dedicated to resolving insurance issues as quickly as possible and exceeding client expectations.
  • Assisted over 7 clients annually.
  • Achieved increased enrollment by 36% annually.
  • Conducted regular audits.

Accomplishments

  • Developed educational materials and conducted training sessions for 7 agents on recent healthcare regulation changes.
  • Trained, evaluated, and provided ongoing feedback for 2 healthcare agents, reducing onboarding time by 5 days.
  • Created client resolution scripts that decreased resolution times by 9% across 7 agents, improving overall call response efficiency.
  • Developed and led regular process-improvement sessions, resulting in a 55% efficiency gain in client service operations.
  • Built and maintained strong relationships with healthcare providers, reducing claim rejection rates by 23% for out-of-network coverage.
  • Documented and resolved program which led to framework.
  • Monitored open enrollment periods for an increased workload of 46%, while retaining 18% customer satisfaction.
  • Partnered with cross-functional teams to launch program, driving a 64% increase in policy sales in targeted regions.
  • Assumed role of primary escalation contact, resolving the most complex client cases with a 25% success rate.
  • Developed and presented data-driven reports to executive teams, enabling decisions that increased approvals on ACA-related claims by 65%.

Affiliations

  • American Marketing Association
  • Society for Health Insurance Professionals (SHIP)
  • International Foundation of Employee Benefit Plans (IFEBP)
  • Association for Supply Chain Management (APICS)
  • Association of Information Technology Professionals
  • Medical Group Management Association (MGMA)
  • American Public Health Association (APHA)
  • Jaycees
  • American College of Healthcare Executives (ACHE)
  • American Association of Healthcare Administrative Management (AAHAM)

Certifications

  • AHIP Certification (America's Health Insurance Plans)
  • Apple Certified Associate (ACA)
  • Project Management Professional (PMP)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • ServSafe
  • Certified Fraud Examiner (CFE) specializing in Healthcare Compliance
  • Certified Professional in Healthcare Management (CPHM)
  • Mental Health Parity and Addiction Equity Act (MHPAEA) Compliance Certification
  • Certified Dementia Practitioner (CDP)
  • Health Care Reform Studies Certification (HCR) by NAHU

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