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Skills

  • Operational improvement
  • Planning and coordination
  • Cross-functional team collaboration
  • Team building
  • Customer service
  • Process improvement strategies
  • Secure data practices
  • Customer satisfaction improvement
  • First Aid/CPR
  • Communications

Work Experiences

  • Finished program of project, which resulted in procedure.
  • Made certain that proper coding was followed in order to maximize efficiency.
  • Double-checked that patients had adequate insurance coverage prior to any procedures or appointment scheduling.
  • Was in charge of all tasks delegated to me, including stakeholder engagement and strategic planning.
  • Increased customer satisfaction by coming up with new ways to solve problems.
  • Adjusted internal practices for compliance.
  • Achieved a 15% customer satisfaction score.
  • Followed specific security rules and guidelines to protect sensitive data, such as patient medical records and payment card information.
  • Adhered to regulatory guidelines.
  • Achieved resolution within program.

Summaries

  • System, standard, and initiative are all available.
  • Provider Enrollment Analyst and team leader with 17 years of experience in system settings.
  • Achieved a 38% accuracy rate.
  • Achieved a 38% boost in productivity.
  • Strategic thinker with expertise in client relations.
  • Healthcare student seeking hands-on experience through an internship in data analysis.
  • Proven track record of motivating spearheaded to achieve team, individual, and management goals.
  • Self-motivated Insurance Verification Specialist with over 8 years of experience learning medical terminology and keeping track of patient coverage.
  • Time management and interpersonal skills are available.
  • Strong technical skills and experience in performance reporting.

Accomplishments

  • Trained 3 new hires on the use of Workday for managing provider enrollment, reducing training time, and accelerating team ramp-up.
  • Received President's Club for exemplary performance in resolving credentialing issues and clearing the enrollment backlog of over 17 provider records.
  • Created a tracking dashboard for provider applications, which improved transparency and accountability and reduced pending applications by 34% in three years.
  • Created audit procedures that contributed to reducing post-enrollment compliance risks by as much as 51%, aligning with federal policies.
  • Developed performance metrics and reporting methods for the provider enrollment team, resulting in clearer insights and a 25% improvement in team productivity.
  • Collaborated with the compliance team to regularly update credentialing policies to reflect changes in federal and state healthcare regulations.
  • Led the integration of Jira to automate provider enrollment tracking, reducing manual errors and enhancing reporting efficiency by 73%.
  • Ensured 8 providers met payer and network adequacy requirements, securing essential contracts and increasing network flexibility by 32%.
  • Authored SOPs for standard, leading to improved process consistency and contributing to an framework certification.
  • Managed ongoing provider re-enrollment projects for procedure, ensuring all documentation met internal and external auditing standards.

Affiliations

  • Volunteer, Healthcare Financial Management Association (HFMA) Credentialing Committee
  • Member, American Academy of Professional Coders (AAPC) – Coding and Compliance Chapter
  • Affiliate Member, Medical Group Management Association (MGMA)
  • Active Member, National Association of Insurance Commissioners (NAIC)
  • Peer Reviewer, Journal of Healthcare Compliance and Credentialing
  • Affiliate, American Association of Healthcare Administrative Management (AAHAM)
  • Professional Certification in Healthcare Regulatory Compliance (HRC) by procedure
  • Contributor, 2023 Provider Data Standardization Taskforce
  • Member, American Health Information Management Association (AHIMA), Provider Data Integrity Division
  • Affiliate Member of Managed Care Enrollment and Credentialing Group

Certifications

  • Certified Professional Biller (CPB)
  • Insurance Payer Contracting and Negotiation Certification (North Carolina)
  • Certified Provider Credentialing Specialist (CPCS)
  • Advanced Certificate in Provider Enrollment Workflow Management
  • Regulatory Affairs Certification (RAC) for Healthcare Providers
  • Healthcare Financial Management Association (HFMA) Certification
  • Certified Revenue Cycle Specialist (CRCS)
  • First Aid/CPR
  • Salesforce
  • Apple Certified Associate (ACA)

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