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Skills

  • Knowledge of ICD-10, CPT, and HCPCS coding standards
  • Relationship development
  • Analytical skills for cost-saving identification
  • Client relationship management
  • Knowledge of payer/provider contracts
  • Organization
  • Team building
  • Ability to resolve high-priority cases quickly
  • Pre-authorization request submission
  • Insurance policy interpretation (HMO, PPO, POS)

Work Experiences

  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Adhered to state laws.
  • Achieved recovery over a six-month period.
  • Communicated complex benefit structures.
  • Conducted regular auditing.
  • Conducted thorough pre-submission audits.
  • Oversaw the delivery of method project by initiative team, which resulted in program.
  • Analyzed and interpreted insurance policies for method plans, ensuring compliance with both state and federal regulations in Phoenix.
  • Kept patient finances, records, and health statuses confidential.
  • Consistently exceeded monthly processing goals by 71%.

Summaries

  • Coached a team of 2 junior specialists.
  • Analytical Medical Insurance Specialist.
  • Medical Insurance Specialist with 16 years of experience, dedicated to providing personalized, courteous service.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Bringing 18 years of insurance experience to the table.
  • Accelerated reimbursements.
  • Adept at preparing and submitting thorough documentation.
  • Achieved a 85% decrease in claim resolution times.
  • Recognized on a regular basis for outstanding performance and contributions to the Customer Service industry's success.
  • Audited documentation for accuracy and compliance.

Accomplishments

  • Drove a comprehensive coding and billing compliance review, reducing future potential audit risks by 77%.
  • Managed a portfolio of high-risk claims, securing reimbursement for standard amounting to $17 during 2023.
  • Processed claims valued over $12, contributing to a 45% reduction in annual revenue losses due to delayed payments.
  • Achieved a reimbursement rate of 62% by collaborating with insurance providers to resolve disputes on 9 high-value claims in 2024.
  • Successfully resolved 59% of claim denials by employing an enhanced claims verification procedure and offering comprehensive justification.
  • Successfully disputed and resolved denied claims, recovering $15 in previously lost revenue for the healthcare provider.
  • Reviewed payer contracts, identifying opportunities for renegotiation that increased annual revenues by $17.
  • Spearheaded the successful integration of a claims management system, improving claims approval rate by 84% and minimizing data entry errors.
  • Researched and integrated the use of QuickBooks into the claims process, resulting in faster claim submissions by 57% hours.
  • Developed and executed a plan to audit insurance claims, discovering $8 in unpaid balances that were subsequently recovered.

Affiliations

  • Professional Association of Health Care Office Management (PAHCOM)
  • Patient Advocate Certification Board (PACB)
  • National Council for Prescription Drug Programs (NCPDP)
  • National Society of Certified Healthcare Business Consultants (NSCHBC)
  • Jaycees
  • Rotary International
  • Society of Human Resource Management
  • American Association of Healthcare Administrative Management (AAHAM)
  • National Association of Insurance Commissioners (NAIC)
  • International Council of Nurses

Certifications

  • ServSafe
  • Revenue Cycle Specialist Certification – HFMA
  • Certified Public Accountant
  • Certified Medical Administrative Specialist (CMAS) – AMT
  • Registered Health Information Technician (RHIT) - AHIMA
  • Certified Healthcare Access Manager (CHAM) framework
  • Project Management Professional (PMP)
  • Certified Specialist in Managed Care (CSMC) - AAHAM
  • Certified Public Accountant (CPA)
  • Health IT and Administration Certificate – framework

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