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Skills

  • Training proficiency
  • Claims accuracy improvement
  • Project organization
  • Financial forecasting and budgeting in healthcare
  • Staff training and development
  • First Aid/CPR
  • Process improvement
  • Vendor onboarding
  • Budgets
  • Government program reimbursement (Medicare/Medicaid)

Work Experiences

  • Communicated reimbursement policies to clinical teams.
  • Achieved a 21% reduction in claim rejections.
  • Was in charge of a variety of benefit programs, including 401K, medical, dental, and vision coverage.
  • Achieved a 52% improvement in payment collection.
  • Collaborated with departmental leaders to identify reimbursement program inefficiencies, creating solutions that boosted overall revenue by $12.
  • Collaborated with initiative customers to determine their needs and deliver standard service.
  • Collaborated with insurance payers to resolve escalated claims.
  • Boosted team productivity by 81%.
  • Analyzed reimbursement data to drive actionable insights, resulting in targeted interventions that lowered patient payment delays by 20%.
  • Collaborated with the IT team to implement an EHR integration, improving claims data accuracy by 56% and decreasing submission delays by 17 days.

Summaries

  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Respectful and resilient thinker with a big-picture mindset.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Accomplished in contract negotiations.
  • Accomplished in contract negotiations, driving a 52% increase in reimbursement rates, significantly enhancing the bottom line for method services.
  • Professional with meticulous attention to detail who can review patient accounts and assist with problem resolution.
  • Benefits plans and compensation frameworks were redesigned to align with the company's cost and quality goals.
  • Avoided financial penalties.
  • Accomplished in streamlining prior authorization processes, achieving a 49% reduction in approval timelines for Salesforce and improving operational efficiency.
  • Reimbursement Manager with 14 years of successful budget management and quality assurance experience.

Accomplishments

  • Consistently ensured compliance with updated healthcare regulations, reducing risk of audits and minimizing the occurrence of rejected claims by 62%.
  • Collaborated with IT teams to automate reimbursement status tracking, reducing manual work by 75% and improving the accuracy of reporting for leadership.
  • Implemented a cross-functional communication process, significantly improving claims follow-up and reducing claim denial rates by 75% within the past year.
  • Took initiative to mentor and train a team of 17 new reimbursement analysts, improving team performance and reducing onboarding time by 44%.
  • Introduced a data-driven approach to prior authorization processes, cutting approval waiting times by 18 days and increasing payer compliance by 82%.
  • Established a real-time analytics dashboard for reimbursement tracking leading to a $181,000 increase in collected receivables annually.
  • Increased reimbursement collections by 66% through enhanced payer negotiation strategies and efficient claims processing.
  • Collaborated with the finance department to restructure reimbursement policies, driving a 62% improvement in reimbursement collection times.
  • Served as the main contact for escalated reimbursement issues, providing expert-level consultancy which resulted in resolving over 7 high-value claims annually.
  • Developed clear reimbursement guidelines that increased accuracy in claims submissions by 82% and minimized errors.

Affiliations

  • Association for Professionals in Infection Control and Epidemiology (APIC)
  • American Academy of Professional Coders (AAPC)
  • Health Insurance Association of America (HIAA)
  • National Association of Independent Review Organizations (NAIRO)
  • Toastmasters
  • Association for Computing Machinery
  • Revenue Cycle Management Certification offered by HFMA
  • Council for Affordable Quality Healthcare (CAQH)
  • Certified Revenue Cycle Representative (CRCR) Program
  • Certified Healthcare Financial Professional (CHFP) Credential

Certifications

  • Apple Certified Associate (ACA)
  • Salesforce
  • Certified in Health Care Compliance (CHC)
  • Certified Healthcare Access Manager (CHAM)
  • Certified Revenue Cycle Professional (CRCP) by HFMA
  • Healthcare Information Security and Privacy Practitioner (HCISPP)
  • Certified Healthcare Billing and Management Executive (CHBME)
  • Certified Professional Coder (CPC) - AAPC
  • Certified Medical Reimbursement Specialist (CMRS)
  • CompTIA A+ Technician

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