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Skills

  • Team building
  • Workflow Optimization
  • Financial forecasting
  • RFI Scanners
  • Business operations
  • Excel for data reconciliation
  • Healthcare provider collaboration
  • Inventory management
  • Administrative support
  • Organization

Work Experiences

  • Analyzed trends in denied claims.
  • Learned performance reporting and quality assurance to help with office needs.
  • Authored internal training materials on payer-specific billing nuances, improving team performance and reducing denial rates by $10 annually.
  • Worked with others to brainstorm new system possibilities.
  • Achieved Outstanding Service Award recognition for compliance excellence in 2023.
  • Finished method of project, which resulted in framework.
  • Attended educational workshops and maintained ITIL, applying new learning to improve reimbursement accuracy across Phoenix.
  • Collaborated closely with team members to meet project deadlines, develop solutions, and deliver project requirements.
  • Achieved a 34% reduction in unresolved claims.
  • Counseled Insurance Reimbursement Specialists on effective strategies for resolving complaints about classification and pay.

Summaries

  • Strong technical skills and experience in budget management.
  • Communicative and team-oriented, with HubSpot expertise.
  • Adaptable specialist in medical claims auditing.
  • Adept at automating claims processing.
  • Adaptable and motivated, with a strong work ethic and the ability to thrive in either a team-based or individually motivated environment.
  • Accelerated the revenue collection process.
  • Ability to recognize category issues and integrate process solutions to achieve procedure.
  • Adhered strictly to compliance protocols.
  • Insurance Reimbursement Specialist and team leader with 15 years of experience in category settings.
  • System, process, and category are all available.

Accomplishments

  • Resolved claim disputes with multiple insurance carriers, reducing backlog by 26% and decreasing average dispute resolution time.
  • Identified inefficiencies in the insurance billing procedure, proposing corrective measures that shortened the revenue cycle by 17 days.
  • Processed 10 claims daily with an accuracy rate of 79%, contributing to a smoother overall reimbursement operation.
  • Created and implemented a tracking system for denied claims, reducing the denial rate by 33% and increasing overall reimbursement collections.
  • Reduced claim denial rates by 52% through the implementation of detailed pre-authorization reviews and consistent follow-up with insurance payers.
  • Collaborated with insurance companies to update policy coverage information, reducing the time spent on verification processes by 42%.
  • Led the effort to reconcile payment discrepancies, recovering $4 in adjusted claims and reducing outstanding balances.
  • Developed and maintained tracking systems for submission and reimbursement reports, offering insights that contributed to improving cash flow by 54%.
  • Performed detailed audits on medical claims submissions to identify areas for process improvement, increasing first-pass claim approval rate by 21%.
  • Revised submission procedures to comply with updated insurance guidelines, reducing the occurrence of denials by 32%.

Affiliations

  • Member, Association for Financial Professionals in Healthcare (AFPH) – Focused on optimizing financial forecasting in healthcare settings.
  • Member, Medical Group Management Association (MGMA) – Participated in advanced training sessions on payer contract negotiations.
  • Attendee, National Conference on Healthcare Reimbursement – Focused on regulatory changes affecting insurance and payer reimbursement tactics.
  • Participant, Annual National Medical Billing Conference – Attended workshops on automation integration for insurance claims submissions.
  • Attended Payor Contracting Optimization Certification Program – Trained in improving reimbursement terms with managed care organizations.
  • Certified Specialist in Managed Care Contracting (CSMCC) – Certification ensuring proficiency in understanding the complexities of managed care contracting.
  • Member, American Health Information Management Association (AHIMA) – Participated in seminars focused on health information management for insurance claims.
  • Certified Professional Coder (CPC) – Certification through AAPC, directly contributing to reimbursement accuracy and claims management.
  • Completed Certification in Healthcare Revenue Integrity from Summit Group – Gained skills in compliance for claims and reimbursement.
  • Certified Healthcare Financial Professional (CHFP) – Specialized training that incorporates financial planning with insurance collection tactics.

Certifications

  • American Academy of Financial Management (AAFM)
  • Claims Adjuster Certified Professional (CACP) - Claims Academy
  • Certified Claims Professional (CCP) - International Claims Association (ICA)
  • CompTIA Network+
  • Cisco Certified Network Associate (CCNA)
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Revenue Integrity Professional (CRIP) – method
  • Certified Professional Biller (CPB) - AAPC
  • Certified Electronic Health Records Specialist (CEHRS) - National Healthcareer Association (NHA)
  • Fundamentals of Healthcare Reimbursement Certificate - Healthcare Financial Management Association (HFMA)

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