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Skills

  • Authorization process streamlining
  • Health insurance
  • First Aid/CPR
  • Project organization
  • Risk mitigation
  • Customer service
  • Insurance authorization
  • Account management
  • Compliance with HIPAA Regulations
  • Claim forecasting

Work Experiences

  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Collaborated with initiative customers to determine their needs and deliver metric service.
  • Looked for industry trends on social media and through online sources.
  • Achieved a 62% success rate for high-priority cases.
  • Achieved a 17% improvement in authorization completion.
  • Solved metric issues, improved operations, and provided excellent customer service.
  • Achieved a 45% success rate in insurance authorization claims.
  • Organized racks and shelves to keep the store looking nice, attract customers, and promote specific items.
  • Coordinated with healthcare providers, insurance companies, and patients to expedite approvals for metric procedures, leading to a 58% reduction in processing delays.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.

Summaries

  • Achieved over 45% compliance accuracy.
  • Accomplished in reducing surgery rescheduling.
  • Achieved a 53% reduction in processing delays for critical procedures.
  • Dedicated to learning, growing, and succeeding in Customer Service.
  • Adept at identifying patterns in denied claims.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Coordinated with insurers for high-priority cases.
  • Recognized on a regular basis for outstanding performance and contributions to the Customer Service industry's success.
  • Collaborated with cross-functional teams.
  • Cut follow-up times by 81%.

Accomplishments

  • Successfully appealed and overturned 46% of initially denied authorizations, securing over $4 in funding for critical treatments.
  • Analyzed insurance premium adjustments and successfully secured approval for coverage adaptation in 2020, leading to cost-savings of $4 for the hospital.
  • Worked in tandem with billing departments to verify coverage limits before conducting expensive procedures, avoiding patient overbilling by $5 annually.
  • Implemented automated tracking mechanisms that improved authorization tracking processes, reducing administrative time by 34% per week.
  • Reduced pending claims backlog by 43% through strategic prioritization and automation of routine authorizations.
  • Identified authorization gaps and resolved 5 delayed cases totaling $12 in lost claim revenue.
  • Facilitated high-priority approvals for specialized treatments by working directly with insurance carriers, avoiding treatment delays for over 15 patients.
  • Introduced a documentation verification step that caught and corrected inaccurate patient information, reducing claim delays by 23% in 18 months.
  • Reduced manual authorization processing time by 77% by integrating departmental workflows with new software solutions.
  • Led audit of insurance verification procedures, increasing accuracy of policy validations by 69% and cutting rework by 26% in 2022.

Affiliations

  • Healthcare Business Management Association (HBMA)
  • Jaycees
  • State Medical Billing and Coding Association in Phoenix
  • Certification in Healthcare Compliance (CHC) through HCCA
  • American Medical Billing Association (AMBA)
  • Certified Professional Compliance Officer (CPCO) through AAPC
  • American Academy of Professional Coders (AAPC)
  • State-level Health Information Management Association (HIMA) in Washington
  • Member of the Hospital Financial Management and Revenue Integrity Group
  • International Association of Administrative Professionals

Certifications

  • Certified Professional Healthcare Risk Manager (CPHRM) - American Hospital Association (AHA)
  • CompTIA Network+
  • Certified Patient Service Specialist (CPSS) - National Healthcareer Association (NHA)
  • Advanced Certified Medical Coder (ACMC) - Vantage
  • Certified Business Analysis Professional (CBAP)
  • Certified Specialist in Healthcare Access (CSHA) - HFMA
  • Certified Medical Office Manager (CMOM) - Practice Management Institute
  • Certified in Healthcare Billing and Coding (CBC) - Cedar Works
  • CompTIA A+ Technician
  • Certified Revenue Integrity Professional (CRIP) – procedure

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