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Skills

  • Project organization
  • Revenue cycle management
  • Advanced proficiency with procedure
  • Customer service
  • Process improvement
  • Caregiver reimbursement
  • Program management
  • Team management
  • Strategic planning
  • Problem resolution

Work Experiences

  • Was in charge of a variety of benefit programs, including 401K, medical, dental, and vision coverage.
  • Oversaw the delivery of process project by system team, which resulted in program.
  • Weekly staff meetings and team building exercises were held, resulting in a positive working environment.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Saved $5 by putting in place cost-cutting measures that addressed long-standing issues.
  • Audited reimbursement discrepancies, identifying over $3 in recoverable funds across 16 healthcare facilities.
  • Collaborated with insurance payers to resolve escalated claims.
  • Reviewed the billing and collections process and identified ways to improve workflows.
  • Solved metric issues, improved operations, and provided excellent customer service.
  • Transported ServiceNow to three years customer locations.

Summaries

  • Achieved 37% improvements in claims accuracy.
  • Achieved a 57% reduction in claim rejections.
  • Achieved faster approval timelines.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Respectful and resilient thinker with a big-picture mindset.
  • Interested in applying my field expertise and sound judgment to a challenging role with Brightline.
  • Reimbursement Manager with exceptional skills in managing a talented team and providing the necessary training.
  • Costs were consistently reduced while profits were increased.
  • Asana and QuickBooks experts.
  • Strengths in strategic planning and vendor management backed up by Healthcare training.

Accomplishments

  • Developed and monitored KPIs for the reimbursement department which resulted in a 24% improvement in process efficiency and a $126,000 increase in revenue.
  • Reduced denied claims by 32% through proactive payer engagement, appeals management, and root cause analysis, driving program.
  • Collaborated with the billing and coding teams to identify and resolve coding issues, leading to a 70% drop in denied claims.
  • Resolved product issue through consumer testing.
  • Consistently ensured compliance with updated healthcare regulations, reducing risk of audits and minimizing the occurrence of rejected claims by 62%.
  • Facilitated communication between the reimbursement, billing, and clinical teams, successfully resolving complex reimbursement discrepancies for strategic planning.
  • Developed a strategic partnership with payers which led to a 31% increase in reimbursement approval rates for specialized services.
  • Orchestrated multiple payer contract negotiations, achieving better reimbursement terms which increased the organization’s bottom line by $$206,000.
  • Led compliance audits of reimbursement processes, resulting in a 38% reduction in discrepancies and avoiding potential payer penalties.
  • Introduced a data-driven approach to prior authorization processes, cutting approval waiting times by 18 days and increasing payer compliance by 82%.

Affiliations

  • International Council of Nurses
  • Toastmasters
  • Revenue Cycle Management Certification offered by HFMA
  • Certification in Healthcare Compliance (CHC) via the Compliance Certification Board
  • Society of Human Resource Management
  • Healthcare Financial Management Association (HFMA)
  • National Association of Social Workers
  • National Association for Healthcare Quality (NAHQ)
  • Freemason
  • National Association of Independent Review Organizations (NAIRO)

Certifications

  • Certified Manager of Patient Accounts (CMPA)
  • ICD-10-CM/PCS Trainer Certification Brightline
  • Fellow of the Healthcare Financial Management Association (FHFMA)
  • Microsoft Certified Systems Engineer (MCSE)
  • Registered Health Information Technician (RHIT)
  • Healthcare Financial Management Association (HFMA) Member
  • Revenue Cycle Representative Certification (RCR) Northwind
  • Certified Medical Administrative Assistant (CMAA)
  • Lean Six Sigma Green Belt Certification - 2020
  • Certified Public Accountant

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