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Skills

  • Compliance with HIPAA Regulations
  • Claims rework minimization
  • Billing Software Proficiency (Adobe Creative Suite)
  • MS Office
  • Financial recovery audits
  • High attention to detail in documentation
  • CPT and HCPCS coding expertise
  • A/R aging reduction strategies
  • Charge entry and coding integrity
  • Process improvement

Work Experiences

  • Challenged and overturned 32% of denied claims.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Oversaw a 10-month project to revamp the filing system, resulting in a 18% increase in department productivity.
  • Actively communicated with patients.
  • Used email and the phone to communicate effectively with staff, patients, and insurance companies.
  • Used classification manuals to learn more about disease and diagnosis processes.
  • Collaborated with procedure customers to determine their needs and deliver program service.
  • Collaborated with healthcare providers.
  • Challenged and overturned 48% of denied claims through timely submission of appeals with proper documentation and coding corrections.
  • Collaborated with billing teams to streamline workflows, reducing claim processing times by 10%.

Summaries

  • Addressed trends in denied claims.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Costs were consistently reduced while profits were increased.
  • Collaborative team player.
  • Advanced knowledge of EOB interpretation and billing error resolution, reducing claim rejection rates by 62% by identifying root causes of denials and implementing corrective action.
  • Achieved a 72% success rate in overturning denied claims.
  • Achieved $17 annual savings for the organization.
  • Analytical problem-solver.
  • Conducted thorough benefit verifications.
  • Collaborative team player with experience working cross-functionally with medical professionals to ensure the accuracy of diagnosis and procedure coding, increasing claim approval rates by 18%.

Accomplishments

  • Performed in-depth payer performance analysis, helping to negotiate improved contract terms and increase revenue by $6.
  • Worked closely with the coding department to ensure proper CPT/ICD-10 coding, reducing underpayments by 13% and improving overall claim accuracy.
  • Researched and implemented Workday, which increased claims filed within the first submission window from 80% to 26%.
  • Resolved product issue through consumer testing.
  • Followed up with process daily, resulting in resolution of 17% of delayed or pending claims within the past year.
  • Increased reimbursement accuracy by validating insurance eligibility and benefits for 17 patients daily, improving upfront collection rates.
  • Collaborated with team of 10 in the development of method.
  • Conducted in-depth audits of payer contracts and recovered over $2 in outstanding revenue related to missed reimbursements or incorrect coding.
  • Improved billing workflow by streamlining interactions with insurance providers, decreasing claim rejection rates by 27% through enhanced coding and documentation.
  • Documented and resolved method which led to category.

Affiliations

  • Participation in Revenue Cycle Improvement Workshops organized by Vantage
  • Certified Professional Coder (CPC) through AAPC
  • American Medical Informatics Association
  • American Health Information Management Association (AHIMA)
  • Healthcare Financial Management Association (HFMA)
  • Participant in the 2023 American Medical Billing Association Reimbursement Certification Program
  • Alumni network of Denver University’s Billing and Reimbursement Certification Program
  • Coding and Billing Expert Panel, organized by initiative
  • Credentialed member of the National Association of Healthcare Revenue Integrity (NAHRI)
  • Local Chapter of AAPC for continued coding education and networking

Certifications

  • Certified Healthcare Financial Professional (CHFP) - Brightline
  • Certified Medical Administrative Assistant (CMAA) - Summit Group
  • Certified Revenue Cycle Specialist (CRCS) Harbor & Co.
  • ServSafe
  • Medical Billing and Coding Certification – Lakeside Partners
  • Certified Professional Biller (CPB) – Cedar Works
  • Certified Public Accountant (CPA)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Specialist Business Intelligence for Healthcare (CSBI) - Northwind
  • Microsoft Certified Systems Engineer (MCSE)

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