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Skills

  • Proficient in Workday
  • Recruiting and training
  • Staff training and motivation
  • Customer service excellence
  • Cardiology
  • Coagulation interventions
  • Claims review
  • Dispute resolution
  • Operational improvement
  • High-risk trauma situations

Work Experiences

  • Special incidents, events, and complaints were investigated, provided, and submitted to the Quality Department.
  • Collaborated and communicated effectively with physicians to ensure client satisfaction and adherence to established standards.
  • Taught employees about state and federal statutes, rules, and regulations that govern home care services.
  • Ensured treatment efficacy by keeping track of treatment regimens.
  • Devised and met financial and growth objectives.
  • Implemented new floor assignments based on the evaluation of staffing requirements.
  • Gave medications to HIV-positive patients and assisted with diagnostic testing.
  • Provided in-home care to children and adults with disabilities.
  • Responded to Code Red pages and made sure that patients were taken care of.
  • Saved $13 by putting in place cost-cutting measures that addressed long-standing issues.

Summaries

  • Surgical procedures, restocking supplies, and updating electronic health records are all things that she can help with.
  • Bilingual Certified Nursing Assistant with 12 years of tracheotomy care experience.
  • With knowledge of ServiceNow use, adept at working closely with midwives and doctors.
  • Professionally trained Claims Analyst with experience providing high-quality culturally competent care to a diverse group of patients.
  • Knowledge of how to use QuickBooks and the ability to triage situations quickly.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Proven leader with experience working in a team environment.
  • Dedicated to long-term problem solving and achieving big-picture objectives.
  • Six Sigma certified
  • Professionally, she is known for being a strong advocate and communicator.

Accomplishments

  • Conducted root cause analysis on elevated claim volumes, implementing corrective actions that reduced workflow bottlenecks by 78%.
  • Supervision: Headed onboarding process for new nursing staff.
  • Perinatal Care: Assisted physicians in focus studies of prenatal care. Performed basic physical assessments of newborns and infants.
  • Patient Advocacy: Explained treatment procedures, medication risks, special diets and physician instructions to patients.
  • Audited closed and pending claims to identify potential recovery opportunities, boosting annual revenue by $40,000.
  • Intensive Care: Responsible for unit of 18 patients, providing daily functions such as grooming, bathing, feeding and turning in bed.
  • Patient Transfer: Safely lifted up to 80 pounds and pushed 300 pounds on wheels.
  • Led claims auditing process for 13 high-value cases, identifying and recovering $235,000 in erroneous or fraudulent payments.
  • Documentation: Documented patient information obtained from intake interviews.
  • Home Aid: Assisted patients with bathing, dressing, daily hygiene and grooming. Provided patients with transportation to and from medical appointments.

Affiliations

  • Toastmasters
  • Project Lead for the Fraud Prevention and Risk Mitigation Task Force - 2021
  • Member of the National Association of Insurance Commissioners (NAIC) - 2024
  • Certified member of the Society of Claims Professionals (SCP) - 2022
  • Certified Claims Professional through the Certification Institute for Loss Adjusters - 2021
  • American Marketing Association
  • National Alliance for Insurance Education and Research affiliate - 2023
  • American Society of Safety Professionals
  • Rotary International
  • Member of the Association of Plaintiff Interstate Claims Professionals (APICP) - 2018

Certifications

  • Certified Business Analysis Professional (CBAP)
  • Current American Academy of Nurse Practitioners (AANP)
  • ANA Certified in Family NP
  • LNHA license
  • Chartered Property Casualty Underwriter (CPCU)
  • LMSW
  • Home Health Aid Certified (HHA)
  • Associate in General Insurance (AINS) – The Institutes
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Holds current furnishing license

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