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Skills

  • Closing processes
  • Business operations
  • Supervision
  • Effective payment arrangements
  • Appealing denied Medicare claims
  • Compliance in healthcare
  • Federal Medicare compliance
  • Communications
  • Aging accounts recovery
  • Data-driven decision making

Work Experiences

  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Assisted in transitioning the Medicare billing system to a digital platform.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Achieved results within 7 months.
  • Avoided fines and penalties.
  • Achieved 42% patient satisfaction.
  • Closed over $2 in outstanding claims annually.
  • Applied effective conflict resolution skills.
  • Assisted Medicare Collectors in properly applying customer remittances while working with Medicare Collector.
  • Achieved results during 2016.

Summaries

  • Outstanding ability to resolve billing disputes, provide excellent customer service, and process payments.
  • Achieved 41% resolution rate for Medicare inquiries.
  • Closed $18 annually.
  • Able to recover high-value balances swiftly.
  • Recognized on a regular basis for outstanding performance and contributions to the Healthcare industry's success.
  • Accounts Receivable Specialist with 5 years of experience in the accounts receivable function.
  • Achieved notable success in reducing outstanding balances by negotiating with insurance representatives and Medicare patients to recover 6.
  • Achieved 59% success in managing difficult accounts.
  • Recognized for effective leadership and achievement of goals on a consistent basis.
  • Adept at Medicare billing audits.

Accomplishments

  • Utilized proprietary billing software and Medicare portals to track claims and denials, achieving a claim submission success rate of 48%.
  • Resolved denials and reworked Medicare appeals, improving collection rates by 61% over a 11-month period.
  • Led the development and implementation of a new Medicare claims workflow, decreasing processing time by 26% hours per claim.
  • Successfully reconciled 4 bulk adjustments from Medicare payers, recapturing revenue of $9 within three years.
  • Streamlined the Medicare billing process by introducing Tableau, improving invoicing accuracy and driving a 6% uplift in the reduction of error-related denials.
  • Collaborated with team of 2 in the development of process.
  • Successfully collected $3 in outstanding Medicare reimbursements, contributing to a 52% increase in overall department revenue.
  • Enhanced system reporting capabilities by customizing electronic health records software, enabling better visibility into Medicare claim statuses and faster remediation.
  • Reported on revenue recovery performance metrics to senior management, highlighting a 37% increase in Medicare collections over several months.
  • Utilized Medicare billing codes and regulations to process 12+ claims per day, achieving a 70% reduction in claim rejections.

Affiliations

  • Health Information and Management Systems Society (HIMSS)
  • American Hospital Association (AHA)
  • Rotary International
  • Healthcare Financial Management Association (HFMA)
  • Society of Women Engineers
  • Certified Healthcare Financial Professional (CHFP)
  • American Association of Healthcare Administrative Management (AAHAM)
  • Freemason
  • National Association of Social Workers
  • International Council of Nurses

Certifications

  • Certified Healthcare Billing Advocate (CHBA) by National Healthcare Collectors Association (NHCA)
  • Certified Professional in Healthcare Quality (CPHQ) with a focus on Medicare compliance by National Association for Healthcare Quality (NAHQ)
  • Medicare Fraud and Abuse Prevention Certificate from Meridian for compliance officials
  • Certified Denial Solutions Professional (CDSP) focusing on overturned Medicare claims, offered by Lakeside Partners
  • Certified Medical Office Manager (CMOM) with CMS regulations focus, by PMI
  • Professional Certification in Medicare & Medicaid Provider Billing & Collections by Cedar Works
  • Salesforce
  • Certified Medicare Collector (CMC) by Academy for Healthcare Revenue & Compliance
  • Certified Medical Collection Professional (CMC-P) by National Healthcare Collectors Association (NHCA)
  • Certified Processional in Revenue Cycle (CPRC) by HFMA

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