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Skills

  • Supervision
  • Compliance with HIPAA Regulations
  • Organization
  • Accurate payment posting
  • Escalation management
  • Relationship development
  • Appeals and grievance resolution
  • Customer service
  • Billing procedures
  • Patient advocacy

Work Experiences

  • Appealed denied insurance claims.
  • Implementing program process improvements increased team efficiency.
  • Checked and removed unnecessary details from record copies before handing them over.
  • Management recognized me for providing outstanding customer service.
  • Collaborated with engineering to ensure seamless integration of billing software with the insurance claims system, saving 10 in annual administrative costs.
  • Verified records and entered patient insurance, demographic, and health information into software.
  • Achieved a 72% decrease in patient complaints.
  • Assisted in reducing financial stress for patients by setting up payment plans and coordinating benefits with 4 different insurance providers.
  • Answered 6 phone calls per three years to assist customers.
  • Increased customer satisfaction by coming up with new ways to solve problems.

Summaries

  • Achieved a 84% reduction in claim denials.
  • Achieved seamless integration.
  • Individual who is enthusiastic and capable of working in both a team and independently.
  • Looking forward to taking on a new challenge with a successful team.
  • In a fast-paced environment, pay attention to deadlines.
  • Ready to take on new challenges in an office setting.
  • Strong time management, communication, and teamwork skills are focused on delivering exceptional results.
  • Accomplished Medical Insurance Coordinator.
  • Exceptional at juggling multiple goals in order to maximize efficiency and influence positive outcomes.
  • Strong technical skills and experience in team leadership.

Accomplishments

  • Proficiently utilized metric to resolve denials related to coding errors, achieving a 58% resolution rate on first appeal.
  • Secured reimbursement on 22% of submitted claims by identifying and resolving documentation or billing-related discrepancies.
  • Reduced claim rejections by 31% by implementing improved coding practices and maintaining up-to-date knowledge of ICD-10 and payer policy changes.
  • Optimized the claims workflow in 2018, leading to a 76% faster processing time for both commercial and governmental programs.
  • Tracked and processed over 12 claims weekly, improving payment cycle time by 52% and reducing aging claims.
  • Recovered over $10 in denied claims through the diligent investigation of payer policies and resubmission of corrected claims.
  • Developed cross-functional relationships with the billing and IT departments to align clinical documentation and billing codes, resulting in a higher clean-claim submission rate.
  • Streamlined the insurance claim submission process, reducing denial rates by 57% through consistent claims follow-up and payer outreach.
  • Exceeded departmental collection goals by 80% through effective claims overseeing and denial resolution in procedure platform.
  • Collaborated with the finance team to identify under-collected insurance payments, recovering $13 in unbilled claims from 2018.

Affiliations

  • Contributed feedback to surveys by the Workgroup for Electronic Data Interchange (WEDI) to help shape future trends in healthcare electronic claims.
  • Certified and engaged in updates via the American Health Information Management Association (AHIMA), focusing on insurance coding and compliance.
  • Networking with fellow medical insurance coordinators through local Boston chapter of the Society for Healthcare Financial Administrators.
  • Increased engagement with the National Association of Healthcare Revenue Integrity, contributing to discussions about regulatory compliance in billing.
  • Member of the American Medical Billing Association (AMBA) since 2021, specializing in regulatory updates and industry best practices.
  • Interacted with healthcare professionals through the Healthcare Administrative Technology Association (HATA), staying informed on billing software advancements.
  • Attended 2015 national conference of the Medical Group Management Association (MGMA) to explore solutions in healthcare administration and insurance challenges.
  • Joined local Denver chapter of the Government Employee Benefits Coordinators to stay informed on federal healthcare policies and member benefits programs.
  • Completed advanced certification in insurance and revenue cycle management through the American Institute of Healthcare Compliance (AIHC).
  • Enrolled in workshops provided by the American Academy of Medical Administrators (AAMA) to refine skills in medical insurance coordination.

Certifications

  • SHRM Senior Certified Professional (SHRM-SCP)
  • CompTIA Security+
  • Apple Certified Associate (ACA)
  • Cisco Certified Internetwork Expert (CCIE)
  • Electronic Health Records Specialist Certification (CEHRS) - method
  • Cisco Certified Network Associate (CCNA)
  • SHRM Certified Professional (SHRM-CP)
  • Certified Revenue Cycle Professional (CRCP) - HFMA
  • Healthcare Revenue Cycle Analyst Certificate - Ironclad Systems
  • First Aid/CPR

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