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Skills

  • Operational improvement
  • Process improvement
  • Business operations
  • Financial reporting and analysis
  • Problem resolution
  • Regulatory compliance understanding
  • Relationship development
  • First Aid/CPR
  • Client and payer relationship management
  • Healthcare financial analysis

Work Experiences

  • Boosted reimbursement rates by standard in 2022.
  • Used Jira to compile data gathered from various sources.
  • Achieved results in 2015.
  • Learned performance reporting and team leadership to help with office needs.
  • Analyzed changes in reimbursement regulations, adapting strategies to avoid a projected $170,000 revenue loss.
  • Achieved a 22% improvement in claims approval rates.
  • Adapted strategies to avoid revenue loss.
  • Achieved results within the first 13 months.
  • Was in charge of all tasks delegated to me, including vendor management and quality assurance.
  • Worked with others to brainstorm new procedure possibilities.

Summaries

  • Analytical Lead Reimbursement Specialist with strong data-gathering, report-writing, and data-compilation abilities.
  • Healthcare student seeking hands-on experience through an internship in client relations.
  • Proven track record of motivating coordinated to achieve team, individual, and management goals.
  • Six Sigma certified
  • Looking forward to taking on a new challenge with a successful team.
  • With a team-oriented mentality, highly organized, proactive, and punctual.
  • Adaptable and motivated, with a strong work ethic and the ability to thrive in either a team-based or individually motivated environment.
  • Achieved a 23% reduction in denials.
  • HubSpot and QuickBooks experts with exceptional interpersonal skills.
  • ServiceNow expert who excels at meeting and exceeding sales targets.

Accomplishments

  • Audited and resolved discrepancies found in processed reimbursements, recovering total missed payments worth $236,000 in 2024.
  • Developed and instituted internal KPI dashboards for claims teams, improving performance tracking and resulting in a 67% quicker claim processing cycle.
  • Streamlined claim appeals process, reducing turnaround time by 14 days and improving reimbursement success by 57%. Achieved a 58% reduction in backlogged claims.
  • Drove continuous improvement initiatives for reimbursement documentation processes, reducing inconsistencies and improving approval times by 31%.
  • Conducted regular internal audits and mock CMS audits to ensure regulatory compliance, achieving zero significant findings in 2016's external audit.
  • Established best practices for reimbursement compliance, leading to a 54% decrease in rejected claims due to incomplete or inaccurate submissions.
  • Collaborated with revenue cycle management to reduce overall Accounts Receivable (AR) aging by 55%, boosting monthly cash flow by $121,000.
  • Advised on Medicare/Medicaid billing standards and compliance regulations, leading to 34% fewer payment denials from regulatory underpayment.
  • Standardized billing and reimbursement processes at Denver, resulting in a 43% increase in claims approved on the first submission.
  • Implemented comprehensive claims verification procedures that improved billing accuracy by 83%, reducing claim errors and denials across the organization.

Affiliations

  • Member, The Health Care Compliance Association (HCCA) – Attended workshops on audit resolution strategies, focusing on Medicare and Medicaid reimbursement procedures.
  • Member, National Revenue Cycle Forum – Actively involved in discussions to improve billing software/system implementation for more accurate reimbursement tracking.
  • Affiliate, Healthcare Billing and Management Association (HBMA) – Participated in peer-led discussions on cutting-edge claims adjudication processes and improved payer engagement.
  • Participant, Medical Group Management Association (MGMA) – Attended specialized workshops on financial reporting metrics for medical claims and payer reconciliation.
  • Affiliate, American Health Information Management Association (AHIMA) – Participated in educational sessions on CMS guidelines and claims discrepancy resolution.
  • Member, Association for Financial Professionals in Healthcare (AFPH) – Participated in ongoing exchanges on financial strategies for reimbursement optimization in the healthcare sector.
  • Certification Holder, Certified Revenue Cycle Representative (CRCR) – Obtained certification in 2015 with a focus on audit preparation and mitigation of financial risks.
  • Participant, Annual Managed Care Reimbursement Summit – Engaged in expert presentations on risk mitigation and advanced problem-solving in the reimbursement space.
  • Active Contributor, Healthcare Financial Revenue Optimization Forum – Regularly contributed case studies focusing on revenue recovery through advanced billing and claims resolution tactics.
  • Member, Healthcare Financial Management Association (HFMA) – Participated in annual conferences to stay updated on industry trends in reimbursement and revenue cycle management.

Certifications

  • Certified Healthcare Access Manager (CHAM) - Brightline
  • First Aid/CPR
  • Certified Revenue Integrity Professional (CRIP) - Meridian
  • Certified Healthcare Compliance Professional (CHCP) - Ironclad Systems
  • Healthcare Financial Management Association (HFMA) Revenue Cycle Certification - Harbor & Co.
  • Salesforce
  • Certified Healthcare Reimbursement Specialist (CHRS) - Northwind
  • Certified Medical Office Manager (CMOM) - Northwind
  • Certified Reimbursement Manager (CRM) - Beacon Labs
  • National Certified Medical Office Manager (NCMOM) - Meridian

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